清醒craniotomy (AC) is employed to maximize tumor resection while preserving neurological function in eloquent brain tissue. This technique is used frequently in adults but remains poorly established in children. Its use has been limited due to concern for children’s neuropsychological differences compared with adults and how these differences may interfere with the safety and feasibility of the procedure. Among studies that have reported pediatric ACs, complication rates and anesthetic management vary. This systematic review was performed to comprehensively analyze outcomes and synthesize anesthetic protocols of pediatric ACs.
开云体育世界杯赔率
The authors followed PRISMA guidelines to extract studies that reported AC in children with intracranial pathologies. The Medline/PubMed, Ovid, and Embase databases were searched from database inception to 2021, using the terms ("awake") AND ("Pediatric*" OR "child*") AND (("brain" AND "surgery") OR "craniotomy"). Data extracted included patient age, pathology, and anesthetic protocol. Primary outcomes assessed were premature conversion to general anesthesia, intraoperative seizures, completion of monitoring tasks, and postoperative complications.
RESULTS
Thirty eligible studies published from 1997 to 2020 were included that described a total of 130 children ranging in age from 7 to 17 years who had undergone AC. Of all patients reported, 59% were male and 70% had left-sided lesions. Procedure indications included the following etiologies: tumors (77.6%), epilepsy (20%), and vascular disorders (2.4%). Four (4.1%) of 98 patients required conversion to general anesthesia due to complications or discomfort during AC. In addition, 8 (7.8%) of 103 patients experienced intraoperative seizures. Furthermore, 19 (20.6%) of 92 patients had difficulty completing monitoring tasks. Postoperative complications occurred in 19 (19.4%) of 98 patients and included aphasia (n = 4), hemiparesis (n = 2), sensory deficit (n = 3), motor deficit (n = 4), or others (n = 6). The most commonly reported anesthetic techniques were asleep-awake-asleep protocols using propofol, remifentanil or fentanyl, a local scalp nerve block, and with or without dexmedetomidine.
CONCLUSIONS
The findings of this systematic review suggest the tolerability and safety of ACs in the pediatric population. Although pediatric intracranial pathologies pose etiologies that certainly may benefit from AC, there is a need for surgeons and anesthesiologists to perform individualized risk-benefit analyses due to the risks associated with awake procedures in children. Age-specific, standardized guidelines for preoperative planning, intraoperative mapping, monitoring tasks, and anesthesia protocols will help to continue minimizing complications, while improving tolerability, and streamlining workflow in the treatment of this patient population.
ABBREVIATIONS
AC = awake craniotomy;GA = general anesthesia;MAC = monitored anesthesia care;SAS = asleep-awake-asleep.
StevanovicA,RossaintR,VeldemanM,BilottaF,CoburnM.Anaesthesia management for awake craniotomy: systematic review and meta-analysis.PLoS One.2016;11(5):e0156448.
Stevanovic
A
,
Rossaint
R
,
Veldeman
M
,
Bilotta
F
,
Coburn
M
.
Anaesthesia management for awake craniotomy: systematic review and meta-analysis
.PLoS One
.
2016
;
11
(
5
):
e0156448
.
27228013)| false
OkunlolaAI,BabalolaOF,OkunlolaCK,AkinmadeA,AbiolaP,OrewoleTO.清醒craniotomy in neurosurgery: shall we do it more often?Interdiscip Neurosurg.2020;21:100770.
Okunlola
AI
,
Babalola
OF
,
Okunlola
CK
,
Akinmade
A
,
Abiola
P
,
Orewole
TO
.
清醒craniotomy in neurosurgery: shall we do it more often?Interdiscip Neurosurg
.
2020
;
21
:
100770
.)| false
Surbeck
W
,
Hildebrandt
G
,
Duffau
H
.
The evolution of brain surgery on awake patients
.Acta Neurochir (Wien)
.
2015
;
157
(
1
):
77
–
84
.
25352088)| false
KhuKJ,DogliettoF,RadovanovicI,et al.Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study.J Neurosurg.2010;112(5):1056–1060.
Khu
KJ
,
Doglietto
F
,
Radovanovic
I
,
Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study
.J Neurosurg
.
2010
;
112
(
5
):
1056
–
1060
.
19612973)| false
Hervey-JumperSL,LiJ,LauD,et al.清醒craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period.J Neurosurg.2015;123(2):325–339.
Hervey-Jumper
SL
,
Li
J
,
Lau
D
,
清醒craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period
.J Neurosurg
.
2015
;
123
(
2
):
325
–
339
.)| false
Alcaraz García-Tejedor
G
,
Echániz
G
,
Strantzas
S
,
Feasibility of awake craniotomy in the pediatric population
.Paediatr Anaesth
.
2020
;
30
(
4
):
480
–
489
.
31997512)| false
DelionM,TerminassianA,LehousseT,et al.Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area.World Neurosurg.2015;84(6):1645–1652.
Delion
M
,
Terminassian
A
,
Lehousse
T
,
Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area
.World Neurosurg
.
2015
;
84
(
6
):
1645
–
1652
.
26164190)| false
SheshadriV,ChandramouliBA.Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report.J Clin Anesth.2016;32:199–202.
EverettLL,van RooyenIF,WarnerMH,ShurtleffHA,SanetoRP,OjemannJG.Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases.Paediatr Anaesth.2006;16(3):338–342.
Everett
LL
,
van Rooyen
IF
,
Warner
MH
,
Shurtleff
HA
,
Saneto
RP
,
Ojemann
JG
.
Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases
.Paediatr Anaesth
.
2006
;
16
(
3
):
338
–
342
.
16490103)| false
SungB,KimHS,ParkJW,ByonHJ,KimJT,KimCS.Anesthetic management with scalp nerve block and propofol/remifentanil infusion during awake craniotomy in an adolescent patient—a case report.Korean J Anesthesiol.2010;59(Suppl):S179–S182.
Sung
B
,
Kim
HS
,
Park
JW
,
Byon
HJ
,
Kim
JT
,
Kim
CS
.
Anesthetic management with scalp nerve block and propofol/remifentanil infusion during awake craniotomy in an adolescent patient—a case report
.Korean J Anesthesiol
.
2010
;
59
(
Suppl
):
S179
–
S182
.)| false
KlimekM,VerbruggeSJ,RoubosS,van der MostE,VincentAJ,KleinJ.清醒craniotomy for glioblastoma in a 9-year-old child.Anaesthesia.2004;59(6):607–609.
Klimek
M
,
Verbrugge
SJ
,
Roubos
S
,
van der Most
E
,
Vincent
AJ
,
Klein
J
.
清醒craniotomy for glioblastoma in a 9-year-old child
.Anaesthesia
.
2004
;
59
(
6
):
607
–
609
.)| false
HagbergCA,GollasA,BerryJM.The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases.J Clin Anesth.2004;16(1):43–47.
Hagberg
CA
,
Gollas
A
,
Berry
JM
.
The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases
.J Clin Anesth
.
2004
;
16
(
1
):
43
–
47
.
14984859)| false
TalabaevM,VenegasK,ZabrodetsG,et al.Result of awake surgery for pediatric eloquent brain area tumors: single-center experience.Childs Nerv Syst.2020;36(11):2667–2673.
Talabaev
M
,
Venegas
K
,
Zabrodets
G
,
Result of awake surgery for pediatric eloquent brain area tumors: single-center experience
.Childs Nerv Syst
.
2020
;
36
(
11
):
2667
–
2673
.
32435891)| false
GadhinglajkarS,VitthalGS,SreedharR,AbrahamM.Anesthesia management of awake craniotomy performed under asleep-awake-asleep technique using laryngeal mask airway: report of two cases.我神经ndia.2008;56(1):65–67.
Gadhinglajkar
S
,
Vitthal
GS
,
Sreedhar
R
,
Abraham
M
.
Anesthesia management of awake craniotomy performed under asleep-awake-asleep technique using laryngeal mask airway: report of two cases
.我神经ndia
.
2008
;
56
(
1
):
65
–
67
.
18310841)| false
StrickerPA,KraemerFW,GaneshA.Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent.J Clin Anesth.2009;21(2):124–126.
Stricker
PA
,
Kraemer
FW
,
Ganesh
A
.
Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent
.J Clin Anesth
.
2009
;
21
(
2
):
124
–
126
.)| false
RiquinE,DinomaisM,MalkaJ,et al.Psychiatric and psychologic impact of surgery while awake in children for resection of brain tumors.World Neurosurg.2017;102:400–405.
Riquin
E
,
Dinomais
M
,
Malka
J
,
Psychiatric and psychologic impact of surgery while awake in children for resection of brain tumors
.World Neurosurg
.
2017
;
102
:
400
–
405
.
28300707)| false
GuarracinoI,IusT,PaulettoG,MaieronM,SkrapM,TomasinoB.Junior-Real Time neuropsychological testing (j-RTNT) for a young patient undergoing awake craniotomy.Brain Cogn.2020;140:105535.
Guarracino
I
,
Ius
T
,
Pauletto
G
,
Maieron
M
,
Skrap
M
,
Tomasino
B
.
Junior-Real Time neuropsychological testing (j-RTNT) for a young patient undergoing awake craniotomy
.Brain Cogn
.
2020
;
140
:
105535
.)| false
SorianoSG,EldredgeEA,WangFK,et al.The effect of propofol on intraoperative electrocorticography and cortical stimulation during awake craniotomies in children.Paediatr Anaesth.2000;10(1):29–34.
Soriano
SG
,
Eldredge
EA
,
Wang
FK
,
The effect of propofol on intraoperative electrocorticography and cortical stimulation during awake craniotomies in children
.Paediatr Anaesth
.
2000
;
10
(
1
):
29
–
34
.
10632906)| false
LabuschagneJ,LeeCA,MutyabaD,MbanjeT,SibandaC.清醒craniotomy in a child: assessment of eligibility with a simulated theatre experience.Case Rep Anesthesiol.2020;2020:6902075.
Labuschagne
J
,
Lee
CA
,
Mutyaba
D
,
Mbanje
T
,
Sibanda
C
.
清醒craniotomy in a child: assessment of eligibility with a simulated theatre experience
.Case Rep Anesthesiol
.
2020
;
2020
:
6902075
.)| false
Serletis
D
,
Bernstein
M
.
Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors
.J Neurosurg
.
2007
;
107
(
1
):
1
–
6
.
17639865)| false
BeezT,BogeK,WagerM,et al.Tolerance of awake surgery for glioma: a prospective European Low Grade Glioma Network multicenter study.Acta Neurochir (Wien).2013;155(7):1301–1308.
Beez
T
,
Boge
K
,
Wager
M
,
Tolerance of awake surgery for glioma: a prospective European Low Grade Glioma Network multicenter study
.Acta Neurochir (Wien)
.
2013
;
155
(
7
):
1301
–
1308
.
23689968)| false
NataliniD,GanauM,RosenkranzR,et al.Comparison of the asleep-awake-asleep technique and monitored anesthesia care during awake craniotomy: a systematic review and meta-analysis.J Neurosurg Anesthesiol.2022;34(1):e1–e13.
Natalini
D
,
Ganau
M
,
Rosenkranz
R
,
Comparison of the asleep-awake-asleep technique and monitored anesthesia care during awake craniotomy: a systematic review and meta-analysis
.J Neurosurg Anesthesiol
.
2022
;
34
(
1
):
e1
–
e13
.
31972627)| false
SouterMJ,RozetI,OjemannJG,et al.Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography.J Neurosurg Anesthesiol.2007;19(1):38–44.
Hammer
GB
,
牲畜贩子
DR
,
Cao
H
,
The effects of dexmedetomidine on cardiac electrophysiology in children
.Anesth Analg
.
2008
;
106
(
1
):
79
–
83
.
18165557)| false
TobiasJD,BerkenboschJW.Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam.South Med J.2004;97(5):451–455.
Huguet
L
,
Lohkamp
LN
,
Beuriat
PA
,
Psychological aspects of awake brain surgery in children-interests and risks
.Childs Nerv Syst
.
2020
;
36
(
2
):
273
–
279
.
31352575)| false
LohkampLN,MottoleseC,SzathmariA,et al.Awake brain surgery in children-review of the literature and state-of-the-art.Childs Nerv Syst.2019;35(11):2071–2077.
Lohkamp
LN
,
Mottolese
C
,
Szathmari
A
,
Awake brain surgery in children-review of the literature and state-of-the-art
.Childs Nerv Syst
.
2019
;
35
(
11
):
2071
–
2077
.
31377911)| false
