Follow-up After Surgery for Cavernous Malformations in Children

Frequency of Office Visits

• Routine postoperative visit, then yearly: The initial visit is scheduled a few weeks after surgery to make sure that the surgical wound has healed and the patient has returned to usual daily activity. The next follow-up visit should be scheduled 6 months later and then yearly together with the parent(s) or caretakers.
• More frequent if epilepsy: For children with epilepsy and neurological deficit, more frequent visits may be needed to follow progress and provide medical management.

Frequency of Imaging

• No consensus: There is no consensus on the optimal frequency of postoperative scanning. Early scanning can helpful to document gross removal of the lesion and to exclude the presence of hematoma.
• Hemosiderin may persist: Hemosiderin often persists for long time on MRI. It may not be easy to judge the completeness of the excision. Comparison of MRIs obtained at different visits may be helpful to detect any new bleeding.
• If multiple lesions, risk persists of de novo formation: Children with multiple foci need longer imaging follow-up every few years in view of the potential for de novo formation.

Other Investigations Required

• Evaluation of epilepsy: Evaluation for epilepsy may be required if seizures persist.