CHANDIGARH, 16.12.24-In a significant breakthrough for pediatric neurosurgery, a team at PGI has successfully performed an awake craniotomy on an 8-year-old female patient—the youngest ever to undergo this innovative procedure at the Institute. This landmark surgery, conducted with the utmost precision and care, marks a new chapter in the treatment of brain tumors in children, notably those located in eloquent areas of the brain.

Awake craniotomy is a specialized surgical technique where the patient remains awake and responsive during the operation, allowing for real-time monitoring of critical brain functions such as language and motor skills. Traditionally performed on adult patients, this complex procedure presents unique challenges in younger demographics due to their limited ability to cooperate amid the fear and anxiety associated with surgery.

Over the past 4-5 years, PGI has successfully integrated awake craniotomy into its routine practice for adult patients. However, the recent case of this young patient, who presented with focal seizures and weakness in her left limbs due to a right-sided large insular glioma, pushed the boundaries of this technique into pediatric surgery.The surgery was performed by Neurosurgeon, Dr. Sushant Kumar Sahoo and supported by Senior Resident Dr. Lalit Tomar,

*Building Rapport for Success*

Before the surgery, extensive preparations were made to build rapport with the young patient. The Neuro anaesthesia team, led by Neuroanesthetists Dr. Rajeev Chauhan, Senior Resident Dr. Mithelesh, and Junior Resident Dr. Manjri, neuromonitoring technician Hitesh Thakur, nursing assistant Ms. Kamal, and OT technician Dr. Gurpreet engaged in detailed discussions about the procedure, educating her about various tasks like recognizing items, counting, and storytelling that she would be required to perform during surgery. This emphasis on communication and trust was crucial in ensuring her active participation throughout the operation.

The success of an awake craniotomy relies heavily on the seamless collaboration among the surgical team, which in this case included Neuroanesthetists and NeuroSurgeons.

*Innovative Techniques for Safe Resection*

During the surgery, the neuroanesthesia team utilized awake sedation to keep the child alert and responsive while monitoring her brain activity. The application of electrical stimulation on the brain’s surface provided vital information regarding functional brain areas, enabling the surgical team to navigate around crucial regions and minimize postoperative deficits.

Thanks to the meticulous planning, skilled execution, and the child's remarkable cooperation, a safe maximal resection of the tumor was performed without any post-operative complications. Following the surgery, the young patient has shown no additional weakness and is recovering well, a testament to the success of the procedure and the skill of the surgical team.

*A New Era for Pediatric Neurosurgery*

This landmark achievement at PGI not only exemplifies the institution’s commitment to advancing pediatric neurosurgical techniques but also sets a precedent for future cases involving awake craniotomies in children. With continued teamwork and innovative approaches, the prospects for treating complex brain tumors in younger patients are advancing rapidly.