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Child's Nervous System

, Volume 35, Issue 11, pp 2071–2077 | Cite as

Awake brain surgery in children—review of the literature and state-of-the-art

  • Laura-Nanna LohkampEmail author
  • Carmine Mottolese
  • Alexandru Szathmari
  • Ludivine Huguet
  • Pierre-Aurelien Beuriat
  • Irène Christofori
  • Michel Desmurget
  • Federico Di RoccoEmail author
Review Article

Abstract

Objective

Awake brain surgery (ABS) is poorly reported in children as it is considered having limited indications due to age and neuropsychological aspects interfering with its feasibility and psychological outcome. The aim of this article is to review the current state-of-the-art of ABS in children and to offer an objective summary of the published literature on diversified outcome aspects of pediatric awake procedures.

Methods

A literature review was performed using the MEDLINE (PubMed) electronic database applying the following MeSH terms to the keyword search within titles and abstracts: “awake brain surgery children,” “awake brain surgery pediatric,” “awake craniotomy children,” “awake craniotomy pediatric,” and “awake surgery children.” Of the initial 753 results obtained from these keyword searches, a full text screening of 51 publications was performed, ultimately resulting in 18 eligible articles for this review.

Results

A total of 18 full text articles reporting the results of 50 patients were included in the analysis. Sixteen of the 18 studies were retrospective studies, comprising 7 case series, 9 case reports, and 2 reviews. Eleven studies were conducted from anesthesiological (25 patients) and 7 from neurosurgical (25 patients) departments. Most of the patients underwent ABS for supratentorial lesions (26 patients), followed by epilepsy surgery (16 patients) and deep brain stimulation (DBS) (8 patients). The median age was 15 years (range 8–17 years). Persistent deficits occurred in 6 patients, (12%), corresponding to minor motor palsies (4%) and neuropsychological concerns (8%). An awake procedure was aborted in 2 patients (4%) due to cooperation failure and anxiety, respectively.

Conclusions

Despite well-documented beneficial aspects, ABS remains mainly limited to adults. This review confirms a reliable tolerability of ABS in selected children; however, recommendations and guidelines for its standardized implementation in this patient group are pending. Recommendations and guidelines may address diagnostic workup and intra-operative handling besides criteria of eligibility, psychological preparation, and coordinated neuropsychological testing in order to routinely offer ABS to children.

Keywords

Awake brain surgery Children Pediatric neurosurgery Neuropsychology Outcome 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no financial or other conflicts of interest in relation to this review and its related research.

References

  1. 1.
    Snyder PJ, Whitaker HA (2013) Neurologic heuristics and artistic whimsy: the cerebral cartography of Wilder Penfield. J Hist Neurosci 22:277–291.  https://doi.org/10.1080/0964704x.2012.757965 CrossRefPubMedGoogle Scholar
  2. 2.
    Berger MS, Ojemann GA (1992) Intraoperative brain mapping techniques in neuro-oncology. Stereotact Funct Neurosurg 58:153–161.  https://doi.org/10.1159/000098989 CrossRefPubMedGoogle Scholar
  3. 3.
    Surbeck W, Hildebrandt G, Duffau H (2015) The evolution of brain surgery on awake patients. Acta Neurochir 157:77–84.  https://doi.org/10.1007/s00701-014-2249-8 CrossRefPubMedGoogle Scholar
  4. 4.
    Serletis D, Bernstein M (2007) Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg 107:1–6.  https://doi.org/10.3171/jns-07/07/0001 CrossRefPubMedGoogle Scholar
  5. 5.
    Beez T, Boge K, Wager M, Whittle I, Fontaine D, Spena G, Braun S, Szelenyi A, Bello L, Duffau H, Sabel M (2013) Tolerance of awake surgery for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir 155:1301–1308.  https://doi.org/10.1007/s00701-013-1759-0 CrossRefPubMedGoogle Scholar
  6. 6.
    Boetto J, Bertram L, Moulinie G, Herbet G, Moritz-Gasser S, Duffau H (2015) Low rate of intraoperative seizures during awake craniotomy in a prospective cohort with 374 supratentorial brain lesions: electrocorticography is not mandatory. World Neurosurg 84:1838–1844.  https://doi.org/10.1016/j.wneu.2015.07.075 CrossRefPubMedGoogle Scholar
  7. 7.
    Gupta DK, Chandra PS, Ojha BK, Sharma BS, Mahapatra AK, Mehta VS (2007) Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study. Clin Neurol Neurosurg 109:335–343.  https://doi.org/10.1016/j.clineuro.2007.01.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Taylor MD, Bernstein M (1999) Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90:35–41.  https://doi.org/10.3171/jns.1999.90.1.0035 CrossRefPubMedGoogle Scholar
  9. 9.
    Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS (2015) Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 123:325–339.  https://doi.org/10.3171/2014.10.jns141520 CrossRefPubMedGoogle Scholar
  10. 10.
    Meng L, Berger MS, Gelb AW (2015) The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist’s perspective. J Neurosurg Anesthesiol 27:310–317.  https://doi.org/10.1097/ana.0000000000000179 CrossRefPubMedGoogle Scholar
  11. 11.
    Paldor I, Drummond KJ, Awad M, Sufaro YZ, Kaye AH (2016) Is a wake-up call in order? Review of the evidence for awake craniotomy. J Clin Neurosci 23:1–7.  https://doi.org/10.1016/j.jocn.2015.11.004 CrossRefPubMedGoogle Scholar
  12. 12.
    Trevisi G, Roujeau T, Duffau H (2016) Awake surgery for hemispheric low-grade gliomas: oncological, functional and methodological differences between pediatric and adult populations. Childs Nerv Syst 32:1861–1874.  https://doi.org/10.1007/s00381-016-3069-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Riquin E, Dinomais M, Malka J, Lehousse T, Duverger P, Menei P, Delion M (2017) Psychiatric and psychological impact of surgery while awake in children for resection of brain tumors. World Neurosurg 102:400–405.  https://doi.org/10.1016/j.wneu.2017.03.017 CrossRefPubMedGoogle Scholar
  14. 14.
    Akay A, Ruksen M, Cetin HY, Seval HO, Islekel S (2016) Pediatric awake craniotomy for brain lesions. Pediatr Neurosurg 51:103–108.  https://doi.org/10.1159/000442988 CrossRefPubMedGoogle Scholar
  15. 15.
    Delion M, Terminassian A, Lehousse T, Aubin G, Malka J, N’Guyen S, Mercier P, Menei P (2015) Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area. World Neurosurg 84:1645–1652.  https://doi.org/10.1016/j.wneu.2015.06.073 CrossRefPubMedGoogle Scholar
  16. 16.
    Air EL, Ostrem JL, Sanger TD, Starr PA (2011) Deep brain stimulation in children: experience and technical pearls. J Neurosurg Pediatr 8:566–574.  https://doi.org/10.3171/2011.8.peds11153 CrossRefPubMedGoogle Scholar
  17. 17.
    Balogun JA, Khan OH, Taylor M, Dirks P, Der T, Carter Snead Iii O, Weiss S, Ochi A, Drake J, Rutka JT (2014) Pediatric awake craniotomy and intra-operative stimulation mapping. J Clin Neurosci 21:1891–1894.  https://doi.org/10.1016/j.jocn.2014.07.013 CrossRefPubMedGoogle Scholar
  18. 18.
    Klimek M, Verbrugge SJ, Roubos S, van der Most E, Vincent AJ, Klein J (2004) Awake craniotomy for glioblastoma in a 9-year-old child. Anaesthesia 59:607–609.  https://doi.org/10.1111/j.1365-2044.2004.03675.x CrossRefPubMedGoogle Scholar
  19. 19.
    Riquin E, Martin P, Duverger P, Menei P, Delion M (2017) A case of awake craniotomy surgery in an 8-year-old girl. Childs Nerv Syst 33:1039–1042.  https://doi.org/10.1007/s00381-017-3463-5 CrossRefPubMedGoogle Scholar
  20. 20.
    Ard J, Doyle W, Bekker A (2003) Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol 15:263–266CrossRefGoogle Scholar
  21. 21.
    Everett LL, van Rooyen IF, Warner MH, Shurtleff HA, Saneto RP, Ojemann JG (2006) Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases. Paediatr Anaesth 16:338–342.  https://doi.org/10.1111/j.1460-9592.2005.01697.x CrossRefPubMedGoogle Scholar
  22. 22.
    Hagberg CA, Gollas A, Berry JM (2004) The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases. J Clin Anesth 16:43–47.  https://doi.org/10.1016/j.jclinane.2003.02.011 CrossRefPubMedGoogle Scholar
  23. 23.
    Maurtua MA, Cata JP, Martirena M, Deogaonkar M, Rezai A, Sung W, Lotto M, Niezgoda J, Schubert A (2009) Dexmedetomidine for deep brain stimulator placement in a child with primary generalized dystonia: case report and literature review. J Clin Anesth 21:213–216.  https://doi.org/10.1016/j.jclinane.2008.06.038 CrossRefPubMedGoogle Scholar
  24. 24.
    McClain CD, Landrigan-Ossar M (2014) Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin 32:83–100.  https://doi.org/10.1016/j.anclin.2013.10.009 CrossRefPubMedGoogle Scholar
  25. 25.
    Sheshadri V, Chandramouli BA (2016) Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report. J Clin Anesth 32:199–202.  https://doi.org/10.1016/j.jclinane.2016.03.009 CrossRefPubMedGoogle Scholar
  26. 26.
    Soriano SG, Eldredge EA, Wang FK, Kull L, Madsen JR, Black PM, Riviello JJ, Rockoff MA (2000) The effect of propofol on intraoperative electrocorticography and cortical stimulation during awake craniotomies in children. Paediatr Anaesth 10:29–34CrossRefGoogle Scholar
  27. 27.
    Sung B, Kim HS, Park JW, Byon HJ, Kim JT, Kim CS (2010) Anesthetic management with scalp nerve block and propofol/remifentanil infusion during awake craniotomy in an adolescent patient -a case report. Korean J Anesthesiol 59 Suppl:S179–S182.  https://doi.org/10.4097/kjae.2010.59.S.S179 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Tobias JD, Jimenez DF (1997) Anaesthetic management during awake craniotomy in a 12-year-old boy. Paediatr Anaesth 7:341–344CrossRefGoogle Scholar
  29. 29.
    Gooden CK, Osborn IP (2010) Venous air embolism during deep brain stimulation surgery in an awake child. Can J Anaesth 57:88–89.  https://doi.org/10.1007/s12630-009-9195-6 CrossRefPubMedGoogle Scholar
  30. 30.
    Sacko O, Lauwers-Cances V, Brauge D, Sesay M, Brenner A, Roux FE (2011) Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 68:1192–1198; discussion 1198-1199.  https://doi.org/10.1227/NEU.0b013e31820c02a3 CrossRefPubMedGoogle Scholar
  31. 31.
    Sanai N, Berger MS (2018) Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol 15:112–125.  https://doi.org/10.1038/nrclinonc.2017.171 CrossRefPubMedGoogle Scholar
  32. 32.
    Szelenyi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M, Neuloh G, Signorelli F, Sala F (2010) Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 28:E7.  https://doi.org/10.3171/2009.12.focus09237 CrossRefPubMedGoogle Scholar
  33. 33.
    Freyschlag CF, Duffau H (2014) Awake brain mapping of cortex and subcortical pathways in brain tumor surgery. J Neurosurg Sci 58:199–213PubMedGoogle Scholar
  34. 34.
    Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358:18–27.  https://doi.org/10.1056/NEJMoa067819 CrossRefPubMedGoogle Scholar
  35. 35.
    Roland JL, Griffin N, Hacker CD, Vellimana AK, Akbari SH, Shimony JS, Smyth MD, Leuthardt EC, Limbrick DD Jr (2017) Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience. J Neurosurg Pediatr 20:583–590.  https://doi.org/10.3171/2017.6.peds1711 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Papanicolaou AC, Rezaie R, Narayana S, Choudhri AF, Wheless JW, Castillo EM, Baumgartner JE, Boop FA (2014) Is it time to replace the Wada test and put awake craniotomy to sleep? Epilepsia 55:629–632.  https://doi.org/10.1111/epi.12569 CrossRefPubMedGoogle Scholar
  37. 37.
    Berger MS (1996) The impact of technical adjuncts in the surgical management of cerebral hemispheric low-grade gliomas of childhood. J Neuro-Oncol 28:129–155CrossRefGoogle Scholar
  38. 38.
    Pasquet A (1954) Combined regional and general anesthesia for craniotomy and cortical exploration. II. Anesthetic considerations. Curr Res Anesth Analg 33:156–164CrossRefGoogle Scholar
  39. 39.
    Milian M, Luerding R, Ploppa A, Decker K, Psaras T, Tatagiba M, Gharabaghi A, Feigl GC (2013) “Imagine your neighbor mows the lawn”: a pilot study of psychological sequelae due to awake craniotomy: clinical article. J Neurosurg 118:1288–1295.  https://doi.org/10.3171/2013.2.jns121254 CrossRefPubMedGoogle Scholar
  40. 40.
    Milian M, Tatagiba M, Feigl GC (2014) Patient response to awake craniotomy - a summary overview. Acta Neurochir 156:1063–1070.  https://doi.org/10.1007/s00701-014-2038-4 CrossRefPubMedGoogle Scholar
  41. 41.
    Santini B, Talacchi A, Casagrande F, Casartelli M, Savazzi S, Procaccio F, Gerosa M (2012) Eligibility criteria and psychological profiles in patient candidates for awake craniotomy: a pilot study. J Neurosurg Anesthesiol 24:209–216.  https://doi.org/10.1097/ANA.0b013e3182464aec CrossRefPubMedGoogle Scholar
  42. 42.
    Potters JW, Klimek M (2015) Awake craniotomy: improving the patient’s experience. Curr Opin Anaesthesiol 28:511–516.  https://doi.org/10.1097/aco.0000000000000231 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Neurosurgery, Hôpital Femme Mère EnfantUniversité Claude Bernard Lyon 1LyonFrance
  2. 2.Center for Cognitive NeuroscienceLyonFrance

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