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Updated: Jun 6, 2026
A Craniotomy Surgery Procedure for Chronic Brain Imaging
Published on: February 15, 2008
Pediatric Awake Craniotomy: An Educational Review
Maria Nabil Henry1,2, Maryam N Shahin3, Ian Stevens3
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Insights
Awake craniotomies are safe for pediatric patients when carefully selected and planned. This approach, involving multidisciplinary teams, minimizes deficits from brain lesion resection near critical areas.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pediatric Medicine
Background:
- Awake craniotomies with functional cortical mapping are used to reduce post-operative deficits in adults and selected pediatric patients.
- Common anesthetic techniques involve "asleep-awake-asleep" protocols using propofol, remifentanil, or fentanyl.
Purpose of the Study:
- To review the unique challenges of awake craniotomies in pediatric patients.
- To present a case study illustrating multidisciplinary care for a pediatric patient undergoing this procedure.
Main Methods:
- Educational review of literature.
- Case presentation of a 9-year-old boy with a peri-rolandic ependymoma.
- Discussion of pre-operative, intra-operative, and post-operative care.
Main Results:
- Awake craniotomies are increasingly applied to well-selected pediatric patients.
- Multidisciplinary care is crucial for successful outcomes.
- The case illustrates effective management strategies.
Conclusions:
- Awake craniotomies can be performed safely in pediatric patients.
- Appropriate patient selection, meticulous planning, and a multidisciplinary approach are essential for success.
Background:
Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were "asleep-awake-asleep" protocols that relied on propofol, remifentanil, or fentanyl.
Main Article:
This educational review discusses the unique challenges that face the anesthesiology and neurosurgical teams when working with the pediatric population. To further illustrate pediatric-specific considerations, a case of a 9-year-old boy who underwent a resection of a large left peri-rolandic ependymoma is presented, including his multidisciplinary pre-operative, intra-operative, and post-operative care.
Conclusion:
Awake craniotomies can safely be performed in the pediatric population with appropriate patient selection, planning, and a multi-disciplinary approach.
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