Considerations for an awake craniotomy in a paediatric patient

Area of Science:

• Neurosurgery
• Pediatric Oncology
• Epilepsy Surgery

Background:

• Awake craniotomy allows real-time neurological assessment during brain tumor resection, maximizing tumor removal and minimizing deficits.
• This procedure is rarely performed in young children.
• A 6-year-old boy with a right frontoparietal tumor and drug-resistant epilepsy was considered for awake craniotomy due to the tumor's eloquent location.

Purpose of the Study:

• To report the youngest case of awake craniotomy in medical literature.
• To demonstrate the feasibility and safety of awake craniotomy in a very young pediatric patient.

Main Methods:

• The patient underwent a comprehensive pre-operative preparation including psychological assessment and theater simulation.
• An asleep-awake-asleep anesthesia technique was utilized.
• Multidisciplinary team collaboration was essential throughout the process.

Main Results:

• Maximum safe tumor resection was achieved without complications.
• The patient experienced no post-operative neurological deficits (speech or motor).
• Postoperative imaging confirmed satisfactory resection, and the patient was discharged seizure-free on day 4.

Conclusions:

• Awake craniotomy is a feasible and well-tolerated procedure in very young pediatric patients when supported by meticulous preparation and a multidisciplinary approach.
• This case highlights the potential for successful awake craniotomy in challenging pediatric neurosurgical cases.