A case of awake craniotomy surgery in an 8-year-old girl

Riquin, Élise; Martin, Paul T.; Duverger, Philippe; Menei, Philippe; Delion, Matthieu

doi:10.1007/s00381-017-3463-5

Cited by 11 publications

(8 citation statements)

References 3 publications

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“…Published reports include the safe completion of awake brain mapping craniotomies in children as young as 8 to 9 yr of age. 26,27 The published failure rate of an awake craniotomy can be low, with 0.5% to 6.4% reported rates of aborted procedures due to intraoperative complication. 14,21,28 Intraoperative stimulationinduced seizures are the most significant predictors of failed or aborted awake language mapping craniotomies.…”

Section: Selecting Patients For Intraoperative Language Mappingmentioning

confidence: 99%

Clinical Pearls and Methods for Intraoperative Awake Language Mapping

Morshed¹,

Young²,

Lee³

et al. 2020

Neurosurg.

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Intraoperative language mapping of tumor and peritumor tissue is a well-established technique for avoiding permanent neurological deficits and maximizing extent of resection. Although there are several components of language that may be tested intraoperatively (eg, naming, writing, reading, and repetition), there is a lack of consistency in how patients are tested intraoperatively as well as the techniques involved to ensure safety during an awake procedure. Here, we review appropriate patient selection, neuroanesthetic techniques, cortical and subcortical language mapping stimulation paradigms, and selection of intraoperative language tasks used during awake craniotomies. We also expand on existing language mapping reviews by considering how intensity and timing of electrical stimulation may impact interpretation of mapping results.

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Section: Selecting Patients For Intraoperative Language Mappingmentioning

confidence: 99%

Clinical Pearls and Methods for Intraoperative Awake Language Mapping

Morshed¹,

Young²,

Lee³

et al. 2020

Neurosurg.

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“…Awake surgery with direct cortical stimulation is considered to be the gold standard for identifying eloquent cortical sites in the adult population [2,17]. Only a few small series, however, have been published regarding this treatment modality in children [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Awake surgery with direct cortical stimulation is a useful surgical approach to help identify and preserve eloquent areas during cortical and subcortical tumor resections, during surgery for arteriovenous malformations, and for resective epilepsy surgery. Despite extensive literature [1,2] in the adult population, only a few small case series [3][4][5][6][7][8][9][10][11][12][13][14][15] have been published regarding this treatment modality in the paediatric population. With decreasing age, a child's ability to cooperate, understand, and manage the stressful surgical environment of an awake craniotomy becomes more and more relevant.…”

Section: Introductionmentioning

confidence: 99%

Awake Craniotomy in a Child: Assessment of Eligibility with a Simulated Theatre Experience

Labuschagne

Lee

Mutyaba

et al. 2020

Case Reports in Anesthesiology

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Background. Awake craniotomy is a useful surgical approach to identify and preserve eloquent areas during tumour resection, during surgery for arteriovenous malformation resections and for resective epilepsy surgery. With decreasing age, a child’s ability to cooperate and mange an awake craniotomy becomes increasingly relevant. Preoperative screening is essential to identify the child who can undergo the procedure safely. Case Description. A 11-year-old female patient presented with a tumour in her right motor cortex, presumed to be a dysembryoplastic neuroepithelial tumour (DNET). We had concerns regarding the feasibility of performing awake surgery in this patient as psychological testing revealed easy distractibility and an inability to follow commands repetitively. We devised a simulated surgical experience to assess her ability to manage such a procedure. During the simulated theatre experience, attempts were made to replicate the actual theatre experience as closely as possible. The patient was dressed in theatre attire and brought into the theatre on a theatre trolley. She was then transferred onto the theatre bed and positioned in the same manner as she would be for the actual surgery. Her head was placed on a horseshoe headrest, and she was made to lie in a semilateral position, as required for the surgery. A blood pressure cuff, pulse oximeter, nasal cannula with oxygen flow, and calf pumps were applied. She was then draped precisely as she would have been for the procedure. Theatre lighting was set as it would be for the surgical case. The application of the monitoring devices, nasal cannula, and draping was meant not only to prepare her for the procedure but to induce a mild degree of stress such that we could assess the child’s coping skills and ability to undergo the procedure. The child performed well throughout the simulated run, and surgery was thus offered. An asleep-awake-asleep technique was planned and employed for surgical removal of the tumour. Cortical and subcortical mapping was used to identify the eloquent tissue. Throughout the procedure, the child was cooperative and anxiety free. Follow-up MRI revealed gross total removal of the lesion. Conclusion. A simulated theatre experience allowed us to accurately determine that this young patient, despite relative contraindications, was indeed eligible for awake surgery. We will continue to use this technique for all our young patients in assessing their eligibility for these procedures.

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“…[7][8][9] Despite these concerns, successfully tolerated awake craniotomies have been reported in pediatric patients as young as 8 years of age with success rates comparable to those of adult patients. 10,11 In the last 2 decades, attempts have been made to delineate eligibility criteria for pediatric patients, such as a minimum age. One review described eligible adult patients as having a high degree of cooperation and motivation, while ineligible patients have considerable anxiety, emotional instability, or inability to concentrate.…”

mentioning

confidence: 99%

“…13 Despite this, several institutions have performed this procedure in patients younger than 10 years. 8,10,14,15 Few institutions have implemented innovative protocols to address concerns of psychological difficulty that may exclude patients from awake craniotomy. Such protocols are directed toward preoperative exposure to the operating room and pre-, intra-, and postoperative involvement of Child Life Specialists implementing tailored intraoperative coping plans.…”

mentioning

confidence: 99%

Awake craniotomy for supratentorial tumors or epileptogenic lesions in pediatric patients: a 16-year retrospective cohort study

Reecher,

Koop,

Awad

et al. 2023

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Awake craniotomy with intraoperative mapping is the widely accepted procedure for adult patients undergoing supratentorial tumor or epileptogenic focus resection near eloquent cortex. In children, awake craniotomies are notably less common due to concerns for compliance and emotional or psychological repercussions. Despite this, successfully tolerated awake craniotomies have been reported in patients as young as 8 years of age, with success rates comparable to those of adults. The authors sought to describe their experience with pediatric awake craniotomies, including insight regarding feasibility and outcomes. METHODS A retrospective review was completed for all pediatric (age < 18 years) patients at Children’s Wisconsin for whom an awake craniotomy was attempted from January 2004 until March 2020. Institutional review board approval was granted. RESULTS Candidate patients had intact verbal ability, cognitive profile, and no considerable anxiety concerns during neuropsychology assessment. Nine patients presented with seizure. Five patients were diagnosed with tumor and secondary epilepsy, 3 with tumor only, and 3 with epilepsy only. All patients who underwent preoperative functional MRI successfully completed and tolerated testing paradigms. A total of 12 awake craniotomies were attempted in 11 patients, with 1 procedure aborted due to intraoperative bleeding. One patient had a repeat procedure. The mean patient age was 15.5 years (range 11.5–17.9 years). All patients returned to or maintained baseline motor and speech functions by the latest follow-up (range 14–130 months). Temporary deficits included transient speech errors, mild decline in visuospatial reasoning, leg numbness, and expected hemiparesis. Of the 8 patients with a diagnosis of epilepsy prior to surgery, 7 patients achieved Engel class I designation at the 1-year follow-up, 6 of whom remained in class I at the latest follow-up. CONCLUSIONS This study analyzes one of the largest cohorts of pediatric patients who underwent awake craniotomy for maximal safe resection of tumor or epileptogenic lesions. For candidate patients, awake craniotomy is safe, feasible, and effective in carefully selected children.

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A case of awake craniotomy surgery in an 8-year-old girl

Cited by 11 publications

References 3 publications

Clinical Pearls and Methods for Intraoperative Awake Language Mapping

Clinical Pearls and Methods for Intraoperative Awake Language Mapping

Awake Craniotomy in a Child: Assessment of Eligibility with a Simulated Theatre Experience

Awake craniotomy for supratentorial tumors or epileptogenic lesions in pediatric patients: a 16-year retrospective cohort study

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