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Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery
Faisal Alsallom1, Mirela V Simon2
1King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and.
Insights
Intraoperative neurophysiologic testing benefits children undergoing brain surgery, similar to adults. These techniques help map brain function and reduce neurological damage, especially for pediatric epilepsy surgery.
Area of Science:
- Pediatric Neurosurgery
- Neurophysiology
- Epileptology
Background:
- Pediatric brain surgery requires specialized neurophysiologic techniques.
- Children's developing brains present unique challenges for intraoperative monitoring.
- Pathologies like neurodevelopmental lesions often cause refractory epilepsy in children.
Purpose of the Study:
- To review intraoperative neurophysiologic testing modalities in pediatric brain surgery.
- To highlight age-specific indications, methodologies, and challenges.
- To emphasize the benefits of these techniques in pediatric neurosurgical procedures.
Main Methods:
- Review of commonly used intraoperative neurophysiologic testing modalities.
- Focus on techniques like electrocorticography for epilepsy surgery.
- Discussion of challenges related to pediatric central and peripheral nervous system development.
Main Results:
- Intraoperative neurophysiologic mapping and monitoring significantly benefit pediatric patients.
- Techniques aid in precise resection of epileptogenic zones in pediatric epilepsy.
- Challenges include anesthetic effects, patient cooperation, and altered cortical excitability.
Conclusions:
- Intraoperative neurophysiologic testing is crucial for safe and effective pediatric brain surgery.
- Despite challenges, these methods improve outcomes by minimizing neurological compromise.
- Accurate mapping and monitoring are vital for treating pediatric epilepsy and other brain pathologies.
Summary:
Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
