Considerations for an awake craniotomy in a paediatric patient

Awake craniotomy facilitates real-time assessment of neurological function and maximises the extent of tumour resection, reducing the risk of postoperative deficits. Awake craniotomy is uncommonly performed in young children. To our knowledge, we report the youngest case of awake craniotomy in medical literature, involving a 6-year-old child. He had a right frontoparietal tumour and a 4-year history of drug-resistant epilepsy. As the tumour was located in an eloquent brain area, an awake craniotomy was planned. Pre-operative preparation included psychological assessment, theatre environment simulation and interpreter-assisted counselling. An asleep-awake-asleep technique was employed. Maximum safe resection was achieved without haemodynamic instability. The patient remained neurologically intact postoperatively, with no speech or motor deficits. Postoperative magnetic resonance imaging demonstrated satisfactory resection. Psychological follow-up confirmed no distress or significant recall of the surgery. He was discharged seizure-free and without any deficit on postoperative day 4. This case shows that with thorough preparation and multidisciplinary teamwork, awake craniotomy is feasible and well tolerated even in very young paediatric patients.