Lohkamp Laura-Nanna, Mottolese Carmine, Szathmari Alexandru, Huguet Ludivine, Beuriat Pierre-Aurelien, Christofori Irène, Desmurget Michel, Di Rocco Federico
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France.
Center for Cognitive Neuroscience, Lyon, France.
Childs Nerv Syst. 2019 Nov;35(11):2071-2077. doi: 10.1007/s00381-019-04279-w. Epub 2019 Aug 3.
Awake brain surgery (ABS) is poorly reported in children as it is considered having limited indications due to age and neuropsychological aspects interfering with its feasibility and psychological outcome. The aim of this article is to review the current state-of-the-art of ABS in children and to offer an objective summary of the published literature on diversified outcome aspects of pediatric awake procedures.
A literature review was performed using the MEDLINE (PubMed) electronic database applying the following MeSH terms to the keyword search within titles and abstracts: "awake brain surgery children," "awake brain surgery pediatric," "awake craniotomy children," "awake craniotomy pediatric," and "awake surgery children." Of the initial 753 results obtained from these keyword searches, a full text screening of 51 publications was performed, ultimately resulting in 18 eligible articles for this review.
A total of 18 full text articles reporting the results of 50 patients were included in the analysis. Sixteen of the 18 studies were retrospective studies, comprising 7 case series, 9 case reports, and 2 reviews. Eleven studies were conducted from anesthesiological (25 patients) and 7 from neurosurgical (25 patients) departments. Most of the patients underwent ABS for supratentorial lesions (26 patients), followed by epilepsy surgery (16 patients) and deep brain stimulation (DBS) (8 patients). The median age was 15 years (range 8-17 years). Persistent deficits occurred in 6 patients, (12%), corresponding to minor motor palsies (4%) and neuropsychological concerns (8%). An awake procedure was aborted in 2 patients (4%) due to cooperation failure and anxiety, respectively.
Despite well-documented beneficial aspects, ABS remains mainly limited to adults. This review confirms a reliable tolerability of ABS in selected children; however, recommendations and guidelines for its standardized implementation in this patient group are pending. Recommendations and guidelines may address diagnostic workup and intra-operative handling besides criteria of eligibility, psychological preparation, and coordinated neuropsychological testing in order to routinely offer ABS to children.
儿童清醒开颅手术（ABS）的报道较少，因为考虑到年龄以及神经心理学方面会影响其可行性和心理结局，其适应证有限。本文旨在综述儿童ABS的当前技术水平，并对已发表的关于儿童清醒手术多方面结局的文献进行客观总结。
使用MEDLINE（PubMed）电子数据库进行文献综述，在标题和摘要的关键词搜索中应用以下医学主题词：“儿童清醒开颅手术”、“小儿清醒开颅手术”、“儿童清醒颅骨切开术”、“小儿清醒颅骨切开术”以及“儿童清醒手术”。从这些关键词搜索得到的753条初始结果中，对51篇出版物进行了全文筛选，最终有18篇符合条件的文章纳入本综述。
分析共纳入18篇报告50例患者结果的全文文章。18项研究中有16项为回顾性研究，包括7个病例系列、9个病例报告和2篇综述。11项研究来自麻醉科（25例患者），7项来自神经外科（25例患者）。大多数患者接受ABS治疗幕上病变（26例患者），其次是癫痫手术（16例患者）和脑深部电刺激（DBS）（8例患者）。中位年龄为15岁（范围8 - 17岁）。6例患者（12%）出现持续性功能缺损，分别对应轻度运动麻痹（4%）和神经心理学问题（8%）。2例患者（4%）因合作失败和焦虑分别导致清醒手术中止。
尽管有充分记录的有益方面，但ABS仍主要限于成人。本综述证实了ABS在特定儿童中的可靠耐受性；然而，针对该患者群体标准化实施的建议和指南尚待制定。除了入选标准、心理准备和协调的神经心理学测试外，建议和指南可能涉及诊断检查和术中处理，以便常规为儿童提供ABS。
