Our Summary

This research paper looks at the use of awake craniotomy in children, a procedure where a patient remains conscious while surgeons operate on their brain. This is normally done when the operation is near important areas of the brain, to help avoid damage. The study looks back at cases between 2009 and 2019 where children underwent this procedure.

The results showed that the procedure could be completed without putting the patient under general anesthesia in 96.7% of the cases. There were some serious complications, such as agitation, seizures, increased brain pressure, breathing problems, and slow heart rate, but all were resolved quickly and without major consequences.

In almost all cases, the surgeons were able to complete the brain mapping needed. Some patients showed new neurological issues after the operation, but these were either moderate or mild and all were gone after six months.

The study concludes that awake craniotomy can be successfully done in children, but it’s crucial that the right patients are chosen and that all the medical professionals involved work closely together. More research is needed to figure out the best anesthetic technique for children undergoing this procedure.

FAQs

  1. What is awake craniotomy and why is it performed in children?
  2. What were the results of the research study on awake craniotomy performed on children between 2009 and 2019?
  3. What complications can arise from awake craniotomy and how can they be resolved?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to follow all pre-operative instructions given by the medical team, including fasting before the surgery and avoiding certain medications. It’s also important to discuss any concerns or questions with the healthcare team and to have a support system in place for after the procedure. Additionally, it’s crucial to attend all follow-up appointments and to follow the post-operative care plan provided by the medical team.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, epilepsy, vascular malformations, traumatic brain injuries, and other conditions that require surgical intervention on the brain. Awake craniotomy may be recommended for patients whose surgery involves critical areas of the brain, such as language or motor function areas, in order to minimize the risk of postoperative neurological deficits. Additionally, patients who are at high risk for complications from general anesthesia may be considered for awake craniotomy. Ultimately, the decision to recommend craniotomy, and whether or not to perform the procedure awake, depends on the specific circumstances of each individual case and should be determined by a team of neurosurgeons, anesthesiologists, and other medical professionals.

Timeline

Before the craniotomy:

  • The patient undergoes a series of neurological tests and imaging studies to determine the location and nature of the brain abnormality requiring surgery.
  • The patient meets with the neurosurgeon to discuss the procedure, risks, and potential outcomes.
  • The patient may undergo preoperative tests such as blood work and electrocardiogram to ensure they are healthy enough for surgery.

During the craniotomy:

  • The patient is brought into the operating room and positioned on the operating table.
  • The patient is given a local anesthetic to numb the scalp and skull.
  • The surgeon creates an opening in the skull to access the brain.
  • In an awake craniotomy, the patient is kept awake to monitor brain function while the surgeon removes the brain tumor or abnormality.
  • The patient may be asked to perform tasks such as speaking or moving limbs to ensure important brain functions are not affected.
  • The surgeon closes the incision in the skull and the patient is taken to the recovery room.

After the craniotomy:

  • The patient is closely monitored in the recovery room for any signs of complications.
  • The patient may experience headaches, nausea, or discomfort in the days following the surgery.
  • The patient may need to stay in the hospital for a few days for observation and pain management.
  • The patient will have follow-up appointments with the neurosurgeon to monitor recovery and discuss any ongoing symptoms or concerns.
  • Physical therapy or rehabilitation may be recommended to help the patient regain strength and function.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with awake craniotomy in children?
  2. How will my child be monitored during the procedure to ensure their safety?
  3. What criteria are used to determine if a child is a suitable candidate for awake craniotomy?
  4. How long does the procedure typically last and what is the recovery process like for children?
  5. What are the potential long-term effects or outcomes of undergoing awake craniotomy in children?
  6. How experienced is the medical team in performing awake craniotomy in children?
  7. Are there any alternative treatment options available for my child’s condition?
  8. What is the success rate of awake craniotomy in children compared to traditional craniotomy under general anesthesia?
  9. Will my child experience any pain or discomfort during the procedure and how will it be managed?
  10. Are there any specific post-operative care instructions or precautions that need to be followed after the procedure?

Reference

Authors: Alcaraz García-Tejedor G, Echániz G, Strantzas S, Jalloh I, Rutka J, Drake J, Der T. Journal: Paediatr Anaesth. 2020 Apr;30(4):480-489. doi: 10.1111/pan.13833. Epub 2020 Feb 13. PMID: 31997512