Chapter 30 - Subcortical mapping during intracranial surgery in children

While resection or disconnection of an epileptogenic lesion may lead to the cessation of seizures, damage to essential networks produces permanent deficits. As current perspectives in neurosurgery have moved from strict cortical localizationism to hodology, intraoperative recognition and preservation of essential cortical–subcortical structures have become a crucial goal for surgical resection. Although the resurgence of awake surgery and the advent of tractography have allowed for unprecedented progression in knowledge and treatment of lesions involving subcortical white matter structures, other strategies may have to be applied in conditions of scarce compliance, such as surgery in pediatric patients. In this scenario, intraoperative neurophysiological monitoring (IOMN) may be the strategy of choice, allowing for the identification of functionally defined but anatomically ambiguous eloquent areas and respective white matter connectivity. Here, we review current advances and future perspectives in mapping subcortical networks in children.