Result of awake surgery for pediatric eloquent brain area tumors: single-center experience.

Abstract

About half of brain tumors are located in supratentorial regions and 20% of them in eloquent brain cortex areas. The use of fMRI and intraoperative neuromonitoring allows safe surgery of these areas. Carrying out awake brain surgery (ABS) operations provides additional opportunities for direct-function monitoring. In pediatric practice, this method has not been used widely yet. We present the retrospective analysis of the results of pre-operative examination and surgical treatment of 12 patients with glial tumors located in eloquent cortex areas. Two patients had ABS operations twice. Intraoperative neuromonitoring was used in all the cases. Twelve patients in total underwent fourteen ABS operations. According to histology results, patients with low-grade tumors prevailed, 11 (91.7%) out of 12. Seven (58.3%) patients had the tumor located in the projection of speech cortex area, four (33.3%) patients in the motor cortex area, and one (8.4%) patient in the visual cortex area. The youngest male was 8 years old. Temporary neurological deficit was diagnosed in three (25%) cases. The tumor was removed completely in 66.7% (eight) cases. Three patients were operated upon twice, two of whom had ABS operations twice. The awake phase of the surgery lasted from 30 to 110 min, 61.2 min on average. Our experience has shown sufficient safety of pediatric ABS operations. The achieved functional result and radicality of tumor removal prove that further application and development of this method for children with eloquent brain area tumors (EBATs) is reasonable.