The value of surveillance scanning, compared to periodic history taking and physical examination, in detection of asymptomatic recurrent tumors was examined in 86 children with posterior fossa medulloblastoma followed regularly between 1980 and 1991 at the Children’s Hospital of Philadelphia. Recurrences were diagnosed in 23 (27%); 4 were detected by scanning only and 19 were associated with symptoms that developed at a median of 4 months after the last scan. No patient survived after a recurrence. 
COMMENT. The authors conclude that surveillance scanning in children with medulloblastoma has limited clinical value. General anesthesia was required for MRI in 10% of children under 4 years of age, and sedation was requested or required by most children under the age of 7 years. More frequent scanning has the disadvantages of morbidity from sedation or anesthesia and increased cost, and earlier detection of recurrence is unlikely to change the outcome. Regular clinical evaluation and scanning are recommended to determine response and change in status after therapy. After a maximal response is achieved, scanning should be based on clinical symptoms and signs. These investigators had reached these conclusions more than 18 months ago and had presented their findings in Oct 1992: (see Ped Neur Briefs Dec 1992;6:94).