Vigilant follow-up is recommended in children after treatment of an intracranial aneurysm, since both the annual risk of recurrence (2.6%) and the annual risk of de novo aneurysm formation (7.8%) are higher than in adults (100,101). In the absence of guidelines, the following recommendations are loosely based on the available literature.
Frequency of Office Visits
- Initial postoperative visit at 4 to 6 weeks: The first postoperative/postprocedural visit should be scheduled 4 to 6 weeks after treatment.
- Additional follow-up visits: In addition to the first postoperative/postprocedural visit with a pediatric neurosurgeon or neurointerventional radiologist, follow-up visits with other specialists, including pediatric neurologists, neuropsychologists, and neurorehabilitation specialists, may be required.
- Annual visits: Subsequent annual visits are recommended, especially during childhood and adolescence.
Frequency of Imaging
- Perioperative scans: In addition to diagnostic imaging, postoperative/postprocedural imaging via angiography (DSA, MRA, and/or CTA) may be required to evaluate treatment outcomes and/or assess for complications such as vasospasm.
- Annual follow-up imaging: Annual MRI and MRA scans are recommended during childhood and adolescence for monitoring. DSA may be considered at 1 and 5 years after treatment.
Other Investigations Required
- Neuropsychological assessment: When there is concern for developmental delay and/or brain injury, neuropsychological testing may be performed as a component of follow-up.
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