• Maria Nabil Henry, Maryam N Shahin, Ian Stevens, Jessica Calvert, Dana Dharmakaya Colgan, Michael Vega, and Kelly Collins.
• Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
• Paediatr Anaesth. 2025 Feb 1.

BackgroundAwake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were "asleep-awake-asleep" protocols that relied on propofol, remifentanil, or fentanyl.Main ArticleThis educational review discusses the unique challenges that face the anesthesiology and neurosurgical teams when working with the pediatric population. To further illustrate pediatric-specific considerations, a case of a 9-year-old boy who underwent a resection of a large left peri-rolandic ependymoma is presented, including his multidisciplinary pre-operative, intra-operative, and post-operative care.ConclusionAwake craniotomies can safely be performed in the pediatric population with appropriate patient sel7ection, planning, and a multi-disciplinary approach.© 2025 John Wiley & Sons Ltd.

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