Awake Craniotomy in 12-Year-Old Pediatric Patients: Preserving Brain Function in High-Risk Tumor Resections

Persistent headaches over two months, accompanied by transient hemiparesis and an episode of brief loss of consciousness, are alarming signs in a 12-year-old boy. Upon examination at University Medical Center Ho Chi Minh City (UMC HCMC), doctors discovered a large brain tumor located directly within eloquent areas critical for motor and language functions. This is an exceptionally sensitive location where any surgical intervention carries the risk of permanent neurological deficits, impairing the patient's mobility, communication, and long-term quality of life if not strictly managed.

Dr. Đỗ Hồng Hải, Head of the Pediatric Neurosurgery Unit within the Department of Neurosurgery, noted that because the tumor was situated adjacent to critical functional areas of the brain, the primary treatment goal was not only tumor resection but also the maximum preservation of the patient's neurological function.

Facing this challenge, the medical team opted for an awake craniotomy-an advanced neurosurgical technique typically indicated for brain lesions near eloquent zones-rather than standard general anesthesia. According to Dr. Đỗ Hồng Hải, an awake craniotomy allows clinicians to directly assess speech and motor functions in real time during the surgery. This enables surgeons to identify safe boundaries when dissecting the tumor, recognize early risks of functional compromise, and adjust maneuvers accordingly to minimize damage to vital neural pathways.                 

mplementing this technique in pediatric patients is exceptionally challenging due to high professional demands and the need for synchronized, multidisciplinary coordination across neurosurgery, pediatric neuro-anesthesiology, nursing, and psychological support. For a 12-year-old patient, helping the child understand, trust, and cooperate throughout the procedure was vital to the overall success of the operation.

Postoperatively, the patient was alert, recovered well, and exhibited no new focal neurological deficits. Follow-up imaging confirmed a near-total tumor resection. The patient continues to be closely monitored with a tailored follow-up plan to ensure comprehensive recovery.

Dr. Trương Thanh Tình, Head of the Department of Neurosurgery at UMC HCMC, emphasized that the successful execution of an awake craniotomy in a pediatric patient demonstrates the hospital's capability to master advanced functional neurosurgical techniques. Beyond maximizing tumor removal, this method plays a crucial role in preserving function and long-term quality of life, particularly for high-risk brain tumors.

In light of this case, specialists advise parents not to overlook neurological warning signs in children, such as persistent headaches, transient limb weakness, or sudden loss of consciousness. Early detection and timely intervention not only enhance treatment efficacy but also safeguard the child's brain function, learning capacity, and long-term development.