Initial Management at Presentation
The initial treatment for tumors arising in the cerebellum in children is surgery with a goal of complete resection in all but the most unusual cases. The aims of surgery are the following:
- Determine the tissue diagnosis: The primary goal of surgery is to obtain tissue for identification of the type of tumor present.
- Treat the tumor: Surgical resection is the primary treatment for low-grade gliomas of the cerebellum, and thus this should be a goal of surgery given that most of these tumors are benign.
- Not indicated in most cases: Adjuvant therapies are considered only in exceptional cases. Chemotherapy and radiation can be considered.
- Imaging: After gross-total resection or near-total resection, patients are followed up with serial MRI scans only. The timing of postoperative MRI scans is controversial. For benign tumors, one reasonable option is to obtain an MRI of the brain immediately postoperatively and then 3 months later. If there has been no recurrence or progression, the next MRI may be obtained 6 months later and annually thereafter.