Abstract
Awake Brain surgery is a procedure in which a patient is awake during the whole or a part of the procedure, for intra-operative mapping for eloquent areas and resection of tumor. In adults, although it is the standard of care for resection in eloquent areas, in pediatric population, it is difficult due to various reasons including procedural difficulty and psychological variability in children. We report a six-year-old right-handed boy presented to us in neurosurgery clinic with the history of partial seizures involving left side of the face and hand, since 2 years of age. He was on three antiepileptics including phenobarbitone, carbamazepine and levetiracetam. On examination, he was a very pleasant boy, awake, alert, oriented to time, place and person. Higher mental functions including long and short-term memory, speech, repetition, and recognition of pictures were normal. There were no motor or sensory deficits in cranial nerve examination and neurological examination of the limbs. MRI revealed a hyper-intense lesion on T2-weighted and FLAIR sequences, contrast-non-enhancing on T1-contrast sequences, in right Frontal lobe in the pre-motor area, abutting and causing pressure on the pre-central gyrus. After consultations with specialist pediatric psychologist, neurologist, neuro-oncologist,s and awake anaesthesia consultant for pre-operative evaluations, he underwent underwent asleep-awake-asleep surgery. Intra-operative mapping was done, the child was in conscious sedation throughout, his left upper and lower limb activities were monitored during mapping and resection of the tumor. The child did not develop any new post-operative deficits. Post operative MRI showed more than 90% of the tumor resected. CONCLUSION: This patient is the youngest child to undergo awake brain tumor surgery reported in the published medical literature yet. Awake craniotomy is feasible and if able to tolerate, makes it possible to do maximum possible resection without causing any lifelong disability to the child.