Research aimed to assess the feasibility, benefit, and safety of awake brain surgery (ABS) and intraoperative language mapping in children and adolescents with structural epilepsy. While ABS is a well-established approach for monitoring language function in adults during surgery, reports of ABS in children are sparse. Between 2008 and 2019, a retrospective case study of juvenile patients 18 years of age who underwent ABS and cortical language mapping for supratentorial tumors and non-tumoral epileptogenic lesions was performed. The authors used extensive neuropsychological testing to assess the patient’s general intellectual and specific language performance, intraoperative compliance, intraoperative language mapping results supported by electrocorticography (ECoG), and postsurgical language development and seizure outcomes. For this investigation, descriptive statistics were utilized, with a statistical significance of p<0.05. 

Eleven children, seven males, with a median age of 13 years (range 10–18 years), received ABS for a lesion near cortical language areas as identified by structural and functional MRI (left hemisphere in 9 children, right hemisphere in 2). Patients were neurologically intact but enduring seizures, which were resistant to treatment in 9 of them. During the awake phase, compliance was great in ten patients and low in one. When compared to preoperative functional MRI, cortical mapping found eloquent language regions in 6/10 (60%) patients, was concordant in 3/8 (37.5%), discordant in 3/8 (37.5%), and uncertain in 2/8 (25%) patients. Stimulation-induced seizures occurred in two patients and were easily stopped. ECoG demonstrated that 5/9 (56%) of patients with speech problems after the stimulation had after-discharge potentials (ADP). There was no postoperative language impairment in any of these patients. Researchers completed Gross-total resection in 10/11 (91 %) patients, and all were seizure-free after a median of 4.3 years of follow-up. Neuropsychological assessment using the Wechsler Intelligence Scale for Children and the verbal learning and memory test revealed an overall nonsignificant trend toward immediate postoperative impairment followed by recovery to preoperative levels after 1 year. ABS is a helpful technique in selected pediatric patients with language-related lesions. A successful operation requires an interdisciplinary approach, careful patient selection, comprehensive preoperative patient teaching, and interpretation of intraoperative ADP.