Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. C URRENT O PINION Anesthesia for intracranial surgery in infants and children Craig D. McClain and Sulpicio G. Soriano Purpose of review Age-related differences in the surgical lesions, anatomy and physiological responses to surgery and anesthesia underlie the clinically relevant differences between pediatric patients and their adult counterparts. Anesthesiologists need to be aware of the unique challenges in the anesthetic management of the pediatric neurosurgical patient. Recent findings Neurosurgeons with subspecialty training in pediatrics have driven advances in intracranial surgery in infants and children. Subspecialization in pediatric neurosurgery and critical care has resulted in more favorable outcomes. Innovations in tumor, epilepsy and endoscopic and cerebrovascular neurosurgery are constantly being adapted to the pediatric patient. The highly specialized nature of these and other pediatric neurosurgical procedures prompt calls for similarly trained anesthesiologists for management of these infants and children. Summary The aim of this review is to highlight the impact of these techniques on the intraoperative management of the pediatric neurosurgical patient. These issues are essential in minimizing perioperative morbidity and mortality. Keywords childhood tumors, epilepsy surgery, neuroanesthesia, pediatric anesthesia INTRODUCTION Childhood intracranial lesions are different from adults’. Brain tumors are the most common solid malignancies in pediatric patients [1], and the histology and location of these tumors are signifi- cantly different from adults. Infants and children with medically intractable seizure disorders are increasingly benefiting from epilepsy surgery [2]. Finally, advances in diagnosis and interventional neuroradiology have increased survival of infants and children with neurovascular lesions. The highly specialized nature of these and other pediatric neurosurgical procedures prompted calls for like- minded and trained perioperative team for manage- ment of these infants and children [3]. This notion has been supported by reports noting that sub- specialzation in pediatric neurosurgery and critical care has resulted in decreased morbidity [4 & ,5]. The developmental stage impacts the anesthetic management of infants and children undergoing intracranial neurosurgery. Age-dependent differ- ences in anatomy, cerebrovascular physiology and neurologic lesions distinguish neonates, infants and children from their adult counterparts. The goal of this review is to highlight these age-dependent differences and their effect on the anesthetic man- agement of the pediatric neurosurgical patient. PREOPERATIVE PREPARATION AND INTRAOPERATIVE MANAGEMENT The preoperative assessment of the pediatric neuro- surgical patients requires a focused approach on areas unique to this surgical cohort. Childhood tumors present with a variety of signs and symptoms that may affect the conduct of anesthesia [6]. These Department of Anesthesiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA Correspondence to Sulpicio G. Soriano, MD, Boston Children’s Hospi- tal, 300 Longwood Avenue, Boston, MA 02115, USA. Tel: +1 617 355 6457; e-mail: sulpicio.soriano@childrens.harvard.edu Curr Opin Anesthesiol 2014, 27:465–469 DOI:10.1097/ACO.0000000000000112 0952-7907 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins www.co-anesthesiology.com REVIEW