Awake Craniotomy in Pediatric Neurosurgery: A Case Report on a 12-Year-Old With Recurrent Ganglioglioma.

Awake craniotomy enables the maximal resection of lesions near the eloquent cortex while preserving neurological function. However, its use in the pediatric population remains limited by challenges of cooperation and anesthetic management. We describe a 12-year-old boy with refractory epilepsy due to the recurrence of a left parietal ganglioglioma previously resected under general anesthesia. Preoperative assessment included neuropsychological testing and familiarization with the operating room environment. An asleep-awake-asleep technique was used, with propofol and remifentanil for induction, a supraglottic device for airway management, and dexmedetomidine for the awake phase. Language mapping with cortical stimulation identified critical areas and guided tumor resection without complications. Recovery was uneventful. At one year, the patient remained seizure-free with no cognitive or psychological deficits. This case highlights the feasibility and safety of awake craniotomy in pediatric patients when supported by meticulous preparation and a multidisciplinary team.