title: Pediatric awake craniotomy and intra-operative stimulation mapping.
abstract: The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population.
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Balogun
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Osaama H
authors.initials: OH
authors.lastname: Khan
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dirks
authors.affiliation: Division of Anesthesiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Der
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Carter Snead Iii
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Shelly
authors.initials: S
authors.lastname: Weiss
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Ayako
authors.initials: A
authors.lastname: Ochi
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Drake
authors.affiliation: Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: james.rutka@sickkids.ca.
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
mesh_terms: D000293:Adolescent; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery; D002648:Child; D003399:Craniotomy / Q000379:methods*; D004568:Electrodiagnosis; D004828:Epilepsies, Partial / Q000601:surgery; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009043:Motor Activity; D038361:Neuronavigation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013060:Speech; D014851:Wakefulness
keywords: Awake craniotomy; Cortical stimulation; Epilepsy; Functional mapping; Language; Neuropsychological; Tumor