{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:13:09Z","timestamp":1783699989426,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Awake craniotomy is well established in adult neurosurgery for lesions near eloquent cortical areas, but its use in children remains uncommon and presents substantial anesthetic, psychological, and organizational challenges. We report the anesthesiologic management of awake craniotomy in a child with constitutional mismatch repair deficiency (CMMRD). Case Presentation: A 10-year-old boy with CMMRD underwent resection of a recurrent left frontal IDH-mutant astrocytoma, WHO grade 3, located adjacent to eloquent language cortex. Because of the high risk of postoperative language impairment, a structured multidisciplinary pathway was implemented, including neurosurgical, neuropsychological, and anesthesiologic evaluation, preoperative familiarization, and intraoperative language testing. An asleep\u2013awake\u2013asleep strategy was used. After induction with propofol, fentanyl, and rocuronium, the airway was secured with a supraglottic airway device (air-Q) followed by fiberoptic-guided tracheal intubation. During the awake phase, propofol was discontinued, remifentanil reduced, and low-dose dexmedetomidine introduced to preserve cooperation. The patient completed intraoperative language mapping, enabling identification of functional language boundaries and safe resection. No major intraoperative adverse events, airway complications, or seizures occurred. Postoperative pain scores remained below 4 on an age-appropriate Numeric Rating Scale, and the patient showed no new neurological deficits. At 1-month follow-up he remained symptom-free. Conclusions: This case adds to the still limited pediatric experience with awake craniotomy and suggests that, in carefully selected children managed within a structured multidisciplinary perioperative pathway and with a tailored anesthetic strategy, the procedure can be performed safely; confirmation in larger series is nonetheless required.<\/jats:p>","DOI":"10.3390\/children13070916","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:13:36Z","timestamp":1783696416000},"page":"916","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Awake Craniotomy Within a Structured Perioperative Pathway: A Case Report of Anesthesiologic Management for Recurrent Astrocytoma in a 10-Year-Old Child"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8882-284X","authenticated-orcid":false,"given":"Francesco","family":"Smedile","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, ARCO, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3554-8442","authenticated-orcid":false,"given":"Dario","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples \u201cFederico II\u201d, Via Pansini, 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2377-3765","authenticated-orcid":false,"given":"Alessandro","family":"Vittori","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, ARCO, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Padua","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, ARCO, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5203-7855","authenticated-orcid":false,"given":"Andrea","family":"Carai","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neurosciences, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Savioli","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, ARCO, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4901-9952","authenticated-orcid":false,"given":"Antonella","family":"Cacchione","sequence":"additional","affiliation":[{"name":"Department of Onco-Hematology, Cell Therapy, Gene Therapy, and Hemopoietic Transplant, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5414-198X","authenticated-orcid":false,"given":"Alessandro","family":"De Benedictis","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neurosciences, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-7439","authenticated-orcid":false,"given":"Rosanna","family":"Pariante","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, ARCO, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Cecchetti","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital (IRCCS), Piazza S. Onofrio 4, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1227\/neu.0000000000002612","article-title":"Awake Versus Asleep Craniotomy for Patients with Eloquent Glioma: A Systematic Review and Meta-Analysis","volume":"94","author":"Sattari","year":"2024","journal-title":"Neurosurgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.3171\/2023.4.PEDS22296","article-title":"Awake craniotomies in the pediatric population: A systematic review","volume":"32","author":"Bhanja","year":"2023","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/pan.15075","article-title":"Pediatric Awake Craniotomy: An Educational Review","volume":"35","author":"Henry","year":"2025","journal-title":"Paediatr. 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