• World Neurosurg · Dec 2015

    Case Reports

    Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area.

    • Matthieu Delion, Aram Terminassian, Thierry Lehousse, Ghislaine Aubin, Jean Malka, Sylvie N'Guyen, Philippe Mercier, and Philippe Menei.
    • Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France. Electronic address: matthieudelion@yahoo.com.
    • World Neurosurg. 2015 Dec 1;84(6):1645-52.

    BackgroundIn 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.ObjectiveThe 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.MethodsSix 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.ResultsThe 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.ConclusionsPreoperative 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.Copyright © 2015 Elsevier Inc. All rights reserved.

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