Awake brain surgery in children-a single-center experience.

Area of Science:

• Pediatric Neurosurgery
• Neuro-oncology
• Clinical Neurology

Background:

• Awake brain surgery (ABS) is rarely performed in children due to age and psychological concerns.
• Advances in neuropsychological testing may improve eligibility for pediatric ABS.
• Limited pediatric case series highlight the complexity of translating ABS to younger patients.

Purpose of the Study:

• To evaluate the practicability and outcomes of awake brain surgery in a pediatric cohort.
• To assess the feasibility of ABS in children with central nervous system (CNS) lesions.
• To analyze the neurological and psychological outcomes following pediatric ABS.

Main Methods:

• Retrospective review and prospective outcome analysis of pediatric patients undergoing ABS (2005-2018).
• Inclusion criteria based on pre-operative MRI documenting eloquent CNS lesions.
• Intraoperative monitoring included electrocortical stimulation during speech or motor tasks.

Main Results:

• Seventeen children (median age 14.8 years) underwent asleep-awake-asleep surgery for glial tumors.
• Complete tumor removal was achieved in 65% of patients.
• Transient neurological deficits occurred in 2 patients; 1 experienced severe psychological reactions; 2 had persistent attention deficits.

Conclusions:

• Awake brain surgery is effective for tumor resection while preserving neurological function in children.
• Thorough psychological preparation for patients and families is crucial for ABS.
• Neuropsychological testing is vital for assessing cognitive outcomes post-surgery.