Pediatric awake craniotomy and intra-operative stimulation mapping

James A. Balogun, Osaama H. Khan, Michael Taylor, Peter Dirks, Tara Der, O. Carter Snead, Shelly Weiss, Ayako Ochi, James Drake, James T. Rutka*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1891-1894
Number of pages4
JournalJournal of Clinical Neuroscience
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2014

Keywords

  • Awake craniotomy
  • Cortical stimulation
  • Epilepsy
  • Functional mapping
  • Language
  • Neuropsychological
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Pediatric awake craniotomy and intra-operative stimulation mapping'. Together they form a unique fingerprint.

Cite this