Anesthesia for Pediatric Stereotactic Radiosurgery

Abstract

STEREOTACTIC radiosurgery has become an important technique to treat various intracranial lesions in children. 1 Providing anesthesia for this therapy differs in several important ways frm other out of the operating room procedures. First, the entire procedure can take 6-10 h and involves the placement of a bulky stereotactic frame around the head, imaging in the magnetic resonance imaging (MRI) suite (and sometimes inthe neuroangiography suite), and transport to at least three different sites in the hospital. Finally, after the stereotactic frame is placed and the magnetic resonance image is obtained, the radiation oncologists require from 1 to 4 h to programl the specific radiation therapy for a particular patient. Because the stereotactic frame must remain in place until the radiation is delivered, young infants and children must remain quiet to avoid displacing this frame. Thus, the patient remains sedated or anesthetized for a prolonged (often umnpredictable) period before the radiation can be delivered. Finally, the anesthesiologist must be able to monitor the patient from outside of the room while the radiation is delivered. For the most part, infants and young children are unable to cooperate for such a complicated and lengthy therapy and, therefore, require general anesthesia or deep sedation to provide conditions that allow accurate imaging and precise delivery of radiation.