title: Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area.
abstract: BACKGROUND
  In the pediatric population, awake craniotomy began to be used for the resection of brain tumor located close to eloquent areas. Some specificities must be taken into account to adapt this method to children.
  
  
  OBJECTIVE
  The aim of this clinical study is to not only confirm the feasibility of awake craniotomy and language brain mapping in the pediatric population but also identify the specificities and necessary adaptations of the procedure.
  
  
  METHODS
  Six children aged 11 to 16 were operated on while awake under local anesthesia with language brain mapping for supratentorial brain lesions (tumor and cavernoma). The preoperative planning comprised functional magnetic resonance imaging (MRI) and neuropsychologic and psychologic assessment. The specific preoperative preparation is clearly explained including hypnosis conditioning and psychiatric evaluation. The success of the procedure was based on the ability to perform the language brain mapping and the tumor removal without putting the patient to sleep. We investigated the pediatric specificities, psychological experience, and neuropsychologic follow-up.
  
  
  RESULTS
  The children experienced little anxiety, probably in large part due to the use of hypnosis. We succeeded in doing the cortical-subcortical mapping and removing the tumor without putting the patient to sleep in all cases. The psychological experience was good, and the neuropsychologic follow-up showed a favorable evolution.
  
  
  CONCLUSIONS
  Preoperative preparation and hypnosis in children seemed important for performing awake craniotomy and contributing language brain mapping with the best possible psychological experience. The pediatrics specificities are discussed.
authors.affiliation: Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France. Electronic address: matthieudelion@yahoo.com.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Delion
authors.affiliation: Department of Anesthesiology, Angers Teaching Hospital, Angers, France.
authors.forename: Aram
authors.initials: A
authors.lastname: Terminassian
authors.affiliation: Department of Anesthesiology, Angers Teaching Hospital, Angers, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lehousse
authors.affiliation: Department of Neuropsychology, Angers Teaching Hospital, Angers, France.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Aubin
authors.affiliation: Department of Child Psychiatry, Angers Teaching Hospital, Angers, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Malka
authors.affiliation: Department of Pediatric Neurology, Angers Teaching Hospital, Angers, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: N'Guyen
authors.affiliation: Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mercier
authors.affiliation: Department of Neurosurgery, Angers Teaching Hospital, Angers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Menei
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D001931:Brain Mapping / Q000379:methods* / Q000523:psychology; D065711:Broca Area / Q000473:pathology / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods* / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006990:Hypnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative; D038361:Neuronavigation; D009483:Neuropsychological Tests; D015173:Supratentorial Neoplasms / Q000523:psychology / Q000601:surgery*; D014851:Wakefulness
keywords: Awake craniotomy; Children; Hypnosis; Language brain mapping; Neuropsychology; Supratentorial brain tumor