Abstract：
BACKGROUND: The goal of surgical management in pediatric low-grade gliomas (pLGGs) is gross total resection (GTR), as it is considered curative with favorable long-term outcomes. Achieving GTR can be challenging in the setting of eloquent-region gliomas, in which resection may increase risk of neurological deficits. Awake craniotomy (AC) with intraoperative neurofunctional mapping (IONM) offers a promising approach to achieve maximal resection while preserving neurological function. However, its adoption in pediatric cases has been hindered, and barriers to its adoption have not previously been elucidated.
RESULTS: This review includes two complementary investigations. First, a survey study was conducted querying pediatric neurosurgeons on their perceived barriers to the procedure in children with pLGG. Next, these critical barriers were analyzed in the context of existing literature. These barriers included the lack of standardized IONM techniques for children, inadequate surgical and anesthesia experience, concerns regarding increased complication risks, doubts about children\'s ability to tolerate the procedure, and perceived non-indications due to alternative monitoring tools.
CONCLUSIONS: Efforts to overcome these barriers include standardizing IONM protocols, refining anesthesia management, enhancing patient preparation strategies, and challenging entrenched beliefs about pediatric AC. Collaborative interdisciplinary efforts and further studies are needed to establish safety guidelines and broaden the application of AC, ultimately improving outcomes for children with pLGG.
RESULTS: This review includes two complementary investigations. First, a survey study was conducted querying pediatric neurosurgeons on their perceived barriers to the procedure in children with pLGG. Next, these critical barriers were analyzed in the context of existing literature. These barriers included the lack of standardized IONM techniques for children, inadequate surgical and anesthesia experience, concerns regarding increased complication risks, doubts about children\'s ability to tolerate the procedure, and perceived non-indications due to alternative monitoring tools.
CONCLUSIONS: Efforts to overcome these barriers include standardizing IONM protocols, refining anesthesia management, enhancing patient preparation strategies, and challenging entrenched beliefs about pediatric AC. Collaborative interdisciplinary efforts and further studies are needed to establish safety guidelines and broaden the application of AC, ultimately improving outcomes for children with pLGG.
摘要：
背景：小儿低度胶质瘤（pLGGs）的手术治疗目标是全切（GTR），因为它被认为具有良好的长期疗效。在雄辩区域神经胶质瘤的背景下，实现GTR可能具有挑战性，其中切除可能会增加神经功能缺损的风险。清醒开颅术（AC）与术中神经功能标测（IONM）提供了一种有希望的方法来实现最大切除，同时保留神经功能。然而,它在儿科病例中的采用受到阻碍，以前还没有阐明采用它的障碍。
结果：本综述包括两项补充调查。首先,我们进行了一项调查研究,询问小儿神经外科医生对pLGG患儿手术的感知障碍.接下来,这些关键障碍是在现有文献的背景下进行分析的。这些障碍包括缺乏针对儿童的标准化IONM技术，手术和麻醉经验不足，对并发症风险增加的担忧，对儿童容忍该程序的能力的怀疑，以及由于替代监测工具而导致的非适应症。
结论：克服这些障碍的努力包括标准化IONM协议，精炼麻醉管理，加强患者准备策略，挑战关于小儿AC的根深蒂固的信念。需要跨学科的合作努力和进一步的研究来建立安全准则和拓宽AC的应用，最终改善pLGG儿童的预后。
结果：本综述包括两项补充调查。首先,我们进行了一项调查研究,询问小儿神经外科医生对pLGG患儿手术的感知障碍.接下来,这些关键障碍是在现有文献的背景下进行分析的。这些障碍包括缺乏针对儿童的标准化IONM技术，手术和麻醉经验不足，对并发症风险增加的担忧，对儿童容忍该程序的能力的怀疑，以及由于替代监测工具而导致的非适应症。
结论：克服这些障碍的努力包括标准化IONM协议，精炼麻醉管理，加强患者准备策略，挑战关于小儿AC的根深蒂固的信念。需要跨学科的合作努力和进一步的研究来建立安全准则和拓宽AC的应用，最终改善pLGG儿童的预后。
