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Updated: Dec 28, 2025
Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
Awake brain surgery in children-a single-center experience
Laura-Nanna Lohkamp1, Pierre-Aurelien Beuriat1,2, Michel Desmurget2
1Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France.
Insights
Awake brain surgery (ABS) in children is feasible for resecting brain lesions near critical areas, preserving neurological function. Careful patient selection and psychological preparation are key to successful outcomes in pediatric neurosurgery.
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.
Introduction:
Awake brain surgery (ABS) represents a rare surgical procedure in children as age and psychological aspects, which are considered to interfere with its feasibility and psychological outcome and limit its application. Only few pediatric case series have been reported so far, indicating a more complex translation of this surgical approach to children. However, the advances in neuropsychological testing and monitoring may have a substantial impact on ameliorating the eligibility of children undergoing awake procedures. This study addresses the condition of ABS in a pediatric cohort, focusing on its practicability and diversified outcome aspects.
Methods:
We performed a retrospective review and prospective outcome analysis of pediatric patients with CNS lesions undergoing ABS between 2005 and 2018, completed at the University of Lyon, France.
Results:
Eighteen children were considered for ABS with respect to the eloquent location of their CNS lesions documented in their pre-operative MRI. Seventeen of them underwent asleep-awake-asleep brain surgery. The cohort included 5 males and 12 females. The median age at surgery was 14.8 years, (range 9.4 to 17.6 years). Intraoperative testing included electrocortical stimulation while pursuing speech or motor activity. Most of the lesions were intrinsic tumors of glial origin. A complete tumor removal was achieved in 11 patients (65%). Post-operative neurological deficits were transiently observed in 2 patients, whereas severe psychological reactions occurred in 1 child. Persistent attention deficits were found in 2 patients. One patient experienced an infectious complication requiring antibiotic treatment. Two patients died during follow-up due to tumor progression. The mean duration of follow up was 22.2 months (range 3.4 to 46.8 months).
Conclusions:
ABS was shown to be beneficial in terms of efficient tumor resection besides simultaneous preservation of neurological functions. Psychological preparation of the families and the children is essential to increase the number and age range of patients, who can benefit from this technique. Neuropsychological testing before and after surgery is essential to determine cognitive outcome, which can be altered in a minority of patients.
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