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Leslie N. Sutton, Avital Cnaan, Laura Klatt, H. Zhao, Robert Zimmerman, Michael Needle, Patricia Molloy, and Peter Phillips

P eriodic surveillance imaging is routinely used for pediatric patients with brain tumors who are asymptomatic posttreatment. The purpose of surveillance is to detect recurrence of tumors before they reach the size at which symptoms occur, assuming that smaller recurrent tumors will be more amenable to treatment. Despite the pervasive use of surveillance imaging in clinical practice, its value for particular tumors is often unproven, and accepted protocols for frequency and duration of imaging have not been established. To be of benefit, an imaging

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David S. Hersh, Jonathan E. Martin, Ruth E. Bristol, Samuel R. Browd, Gerald Grant, Nalin Gupta, Todd C. Hankinson, Eric M. Jackson, John R. W. Kestle, Mark D. Krieger, Abhaya V. Kulkarni, Casey J. Madura, Jonathan Pindrik, Ian F. Pollack, Jeffrey S. Raskin, Jay Riva-Cambrin, Curtis J. Rozzelle, Jodi L. Smith, and John C. Wellons III

-up, timing and modality of imaging, and duration of surveillance have not been clearly defined. 2 – 8 Furthermore, late ETV failure appears to be uncommon, 9 – 11 and the need to use different surveillance protocols for patients with shunts and those treated with an ETV remains unclear. A recent survey of 122 pediatric neurosurgeons at sites for the Hydrocephalus Clinical Research Network (HCRN) or its implementation/quality improvement arm (HCRNq) provided a cross-sectional overview of current practice patterns across North America. 12 Although standardization of

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Paul Steinbok, Stephen Hentschel, D. Douglas Cochrane, and John R. W. Kestle

A standard part of the management of pediatric brain tumors includes serial follow-up computerized tomography (CT) and/or magnetic resonance (MR) imaging of the brain. The purpose of using these imaging techniques is 1) to document the response to treatment; 2) to provide a baseline against which to judge future imaging, so that diagnosis of recurrence or complications of treatment can be facilitated; 3) to look for evidence of recurrence when new symptoms or signs are present; and 4) for surveillance to detect asymptomatic tumor recurrence. Scheduling

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Joseph C. Serrone, Ryan D. Tackla, Yair M. Gozal, Dennis J. Hanseman, Steven L. Gogela, Shawn M. Vuong, Jennifer A. Kosty, Calen A. Steiner, Bryan M. Krueger, Aaron W. Grossman, and Andrew J. Ringer

conservative approach toward managing small anterior circulation UIAs, which includes observation with surveillance imaging. 2 , 20 , 36 Recent series have shown that aneurysm growth increases the risk of subsequent rupture. 13 , 31 This finding has led many physicians to recommend treatment for UIAs with observed growth. The rate of growth, pattern of growth (linear vs episodic), rate of de novo aneurysm formation, and risk factors for growth are inconsistent in the current literature, thus warranting further study in this area. 4 , 5 , 7 , 8 , 13 , 17 , 19 , 22–24 , 27

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Kristin Huntoon, Matthew J. Shepard, Rimas V. Lukas, Ian E. McCutcheon, Anthony B. Daniels, and Ashok R. Asthagiri

. Throughout this article, we use the term “screening” to refer to primary assessment, either through clinical examination or else through imaging, of asymptomatic patients who have never had a CNS hemangioblastoma, or to secondary surveillance of asymptomatic patients who have had prior CNS hemangioblastomas, but who have been previously treated. The term “surveillance” is used in this article to refer to serial assessment, through clinical assessment, imaging, or known existing asymptomatic CNS hemangioblastomas. Neither is used to refer to clinical assessments or imaging

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Andrew J. Dodgshun, Wirginia J. Maixner, Jordan R. Hansford, and Michael J. Sullivan

P ilocytic astrocytomas (PAs) are one of the most common pediatric CNS tumors. Optimal management is resection, and long-term survival is known to be excellent for patients in whom gross-total resection (GTR) is able to be achieved. 1 Recurrence after GTR is uncommon, and reported rates vary between 0% 8 and 29%. 10 Some have advocated no surveillance after GTR, 7 but, in practice, it is likely that MRI scans are being obtained for the reassurance of both the clinician and the patient/patient's family. There have been recent reports suggesting that

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Daxa M. Patel, R. Shane Tubbs, Gigi Pate, James M. Johnston Jr., and Jeffrey P. Blount

Furthermore, recent evolution of MRI pulse sequences now allows for visibility of ventricular characteristics in the pediatric population. 13 , 17 , 18 , 21 The T2-weighted single-shot fast spin echo demonstrates ventricular size and gradient recalled-echo visualizes the shunt catheter. Nevertheless, to date, only 3 investigations of the utility of fsMRI for hydrocephalus assessment have been performed, and 2 of these were feasibility studies nearly 10 years ago. 1 , 15 , 20 We have incorporated an fsMRI protocol into our routine shunt surveillance and investigate its

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James M. Drake, Jay Riva-Cambrin, Andrew Jea, Kurtis Auguste, Mandeep Tamber, and Maria Lamberti-Pasculli

accreditation. Expanding this process to prospective surveillance of complications for an entire service can be accomplished with modest additional effort, and provides important information on the incidence of complications, particularly those common to different procedures. The use of standardized definitions of complications would allow comparison between centers, so that those with higher rates could investigate and address them, leading to improved patient care. Disclosure The authors report no conflict of interest concerning the materials or methods used in this

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David S. Hersh, Rahul Kumar, Paul Klimo Jr., Markus Bookland, and Jonathan E. Martin

Additionally, there is a lack of consensus regarding the use of radiological surveillance for asymptomatic patients, with some providers obtaining imaging studies only in response to concerning signs and symptoms and others performing imaging at routine intervals. 10 , 12–14 To further investigate this issue, we surveyed surgeons who work at hospitals that are part of the Hydrocephalus Clinical Research Network (HCRN) or its implementation/quality improvement arm (HCRNq). The HCRN is a network of 14 sites collaborating on prospective hydrocephalus research projects, whereas

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David S. Hersh, Rahul Kumar, Paul Klimo Jr., Markus Bookland, and Jonathan E. Martin

Additionally, there is a lack of consensus regarding the use of radiological surveillance for asymptomatic patients, with some providers obtaining imaging studies only in response to concerning signs and symptoms and others performing imaging at routine intervals. 10 , 12–14 To further investigate this issue, we surveyed surgeons who work at hospitals that are part of the Hydrocephalus Clinical Research Network (HCRN) or its implementation/quality improvement arm (HCRNq). The HCRN is a network of 14 sites collaborating on prospective hydrocephalus research projects, whereas