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Considerations for an awake craniotomy in a paediatric patient
S M Z Naqvi1, A Akram1, A Iqbal1
1Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan.
Insights
This study reports the youngest patient, a 6-year-old, to undergo successful awake craniotomy for a brain tumor. Thorough preparation and teamwork made this complex procedure safe and effective in a pediatric 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.
Abstract:
Awake craniotomy facilitates real-time assessment of neurological function and maximises the extent of tumour resection, reducing the risk of postoperative deficits. Awake craniotomy is uncommonly performed in young children. To our knowledge, we report the youngest case of awake craniotomy in medical literature, involving a 6-year-old child. He had a right frontoparietal tumour and a 4-year history of drug-resistant epilepsy. As the tumour was located in an eloquent brain area, an awake craniotomy was planned. Pre-operative preparation included psychological assessment, theatre environment simulation and interpreter-assisted counselling. An asleep-awake-asleep technique was employed. Maximum safe resection was achieved without haemodynamic instability. The patient remained neurologically intact postoperatively, with no speech or motor deficits. Postoperative magnetic resonance imaging demonstrated satisfactory resection. Psychological follow-up confirmed no distress or significant recall of the surgery. He was discharged seizure-free and without any deficit on postoperative day 4. This case shows that with thorough preparation and multidisciplinary teamwork, awake craniotomy is feasible and well tolerated even in very young paediatric patients.
