Table 4.

Guideline Recommendations for non-optic pathway glioma (non-OPG: low- or high-grade brain or spine glioma) in children.

Non-optic pathway glioma in children
No	Recommendations	Strength
1	Families with children with NF1 should be educated about possible symptoms and signs of brain tumours.	moderate
2	Clinical assessment should take the form of patient history taking and examination for signs of brain tumours (amongst others new onset or change in seizures, unusual or concerning headache, endocrine problems related to hypothalamic dysfunction, focal neurological deficits, neuropsychological deficits) and should be repeated at every clinical visit from diagnosis.	moderate
3	Routine diagnostic imaging screening for non-OPG, in children who are well (see previous recommendation), is not indicated. However, in a child with clinical concern for a brain tumour, e.g. in the presence of symptoms or endocrine dysfunction, then investigative imaging should be recommended.	moderate
4	Symptomatic non-OPG in children with NF1 should be treated by the same care pathway as sporadic non-OPG in children without NF1. A multidisciplinary team should guide on appropriate therapeutic agents in the setting of NF1. Radiotherapy should be avoided, if at all possible, and is not indicated in low-grade glioma, whilst recognising that it may be required as an important treatment option in the setting of high-grade glioma.	moderate

Note. NF1 = Neurofibromatosis type 1; OPG = optic pathway glioma.