Pediatric awake craniotomy and intra-operative stimulation mapping

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Neuro-oncology
• Epilepsy Surgery

Background:

• Operating on brain lesions near eloquent areas requires balancing resection benefits against neurological deficit risks.
• Awake craniotomy with intra-operative mapping is established in adults for tumor, epilepsy, and functional neurosurgery.
• This technique facilitates maximal tumor resection and reduces post-operative speech and motor deficits.

Purpose of the Study:

• To evaluate the safety and efficacy of awake craniotomy and cortical stimulation in a pediatric population.
• To assess the technique for resecting epilepsy and supratentorial tumors in or near eloquent brain areas in children.

Main Methods:

• Retrospective review of 10 pediatric patients (5 female) undergoing awake craniotomy.
• Lesions were located in or near eloquent cortical areas (opercular, precentral, peri-sylvian regions).
• Intra-operative cortical stimulation mapping was used for speech and/or motor pathways.

Main Results:

• No permanent post-operative neurological deficits were observed in any patient.
• Gross total resection was achieved for tumors; focal cortical resections were completed for epilepsy.
• One patient experienced transient mild word-finding difficulty, which resolved progressively.

Conclusions:

• Pediatric awake craniotomy with intra-operative mapping is a precise, safe, and reliable method for lesion resection in eloquent areas.
• The technique allows for maximal safe resection in pediatric patients with brain tumors and epilepsy.
• Further studies with larger cohorts are needed to confirm its utility in the pediatric population.