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Colgan DD, Eddy A, Aulet-Leon M, Green K, Peters B, Shangraw R, Han SJ, Raslan A, Oken B. Compassion, communication, and the perception of control: a mixed methods study to investigate patients' perspectives on clinical practices for alleviating distress and promoting empowerment during awake craniotomies. Br J Neurosurg 2024; 38:911-922. [PMID: 34850642 PMCID: PMC9156730 DOI: 10.1080/02688697.2021.2005773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To inquire into clinical practices perceived to mitigate patients' intraoperative distress during awake craniotomies. METHODS This mixed-methods study involved administration of Amsterdam Preoperative Anxiety and Information Scale and PTSD Checklist prior to the awake craniotomy to evaluate anxiety and information-seeking related to the procedure and symptoms of PTSD. Generalized Anxiety Disorder Scale and Depression Module of the Patient Health Questionnaire were administered before and after the procedure to evaluate generalized anxiety and depression. Patient interviews were conducted 2-weeks postprocedure and included a novel set of patient experience scales to assess patients' recollection of intraoperative pain, overall distress, anxiety, distress due to noise, perception of empowerment, perception of being well-prepared, overall satisfaction with anaesthesia management, and overall satisfaction with the procedure. Qualitative data were analysed using conventional content analysis. RESULTS Participants (n = 14) had undergone an awake craniotomy for tissue resection due to primary brain tumours or medically-refractory focal epilepsy. Validated self-report questionnaires demonstrated reduced levels of generalized anxiety (pre mean = 8.66; SD = 6.41; post mean= 4.36; SD = 4.24) following the awake craniotomy. Postprocedure interviews revealed very high satisfaction with the awake craniotomy and anaesthesia management and minimal levels of intraoperative pain, anxiety, and distress. The most stressful aspects of the procedure included global recognition of medical diagnosis, anxiety provoked by unfamiliar sights, sounds, and sensations, a perception of a lack of information or misinformation, and long periods of immobility. Important factors in alleviating intraoperative distress included the medical team's ability to promote patient perceptions of control, establish compassionate relationships, address unfamiliar intraoperative sensations, and deliver effective anaesthesia management. CONCLUSION Compassion, communication, and patient perception of control were critical in mitigating intraoperative distress. Clinical practice recommendations with implications for all clinicians involved in patient care during awake craniotomies are provided. Use of these interventions and strategies to reduce distress are important to holistic patient care and patient experiences of care and may improve the likelihood of optimal brain mapping procedures to improve clinical outcomes during awake craniotomies.
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Affiliation(s)
| | - Ashely Eddy
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Kaylie Green
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Betts Peters
- Institute on Development & Disability, Oregon Health and Science University, Portland, OR, USA
| | - Robert Shangraw
- Department of Anaesthesiology and Perioperative Medicine, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Ahmed Raslan
- Neurosurgery Department, Oregon Health and Science University, Portland, OR, USA
| | - Barry Oken
- Neurology Department, Oregon Health and Science University, Portland, OR, USA
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Papatzalas C, Fountas K, Kapsalaki E, Papathanasiou I. The Use of Standardized Intraoperative Language Tests in Awake Craniotomies: A Scoping Review. Neuropsychol Rev 2021; 32:20-50. [PMID: 33786797 DOI: 10.1007/s11065-021-09492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Assessment of speech and language functions is an essential part of awake craniotomies. Although standardized and validated tests have several advantages compared to homemade (or mixed) batteries, in the literature it is unclear how such tests are used or whether they are used at all. In this study, we performed a scoping review in order to locate standardized and validated intraoperative language tests. Our inquiry included two databases (PubMED and MEDLINE), gray literature, and snowball referencing. We discovered 87 studies reporting use of mixed batteries, which consist of homemade tasks and tests borrowed from other settings. The tests we found to meet the validation and standardization criteria we set were ultimately three (n = 3) and each one has its own advantages and disadvantages. We argue that tests with high sensitivity and specificity not only can lead to better outcomes postoperatively, but they can also help us to gain a better understanding of the neuroanatomy of language.
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Affiliation(s)
- Christos Papatzalas
- Department of Medicine, University of Thessaly, Larisa, Greece.
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece.
| | - Kostas Fountas
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Radiology, University Hospital of Larisa, Larisa, Greece
| | - Ilias Papathanasiou
- Department of Speech & Language Therapy, University of Patras, Patras, Greece
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Batra P, Bandt SK, Leuthardt EC. Resting state functional connectivity magnetic resonance imaging integrated with intraoperative neuronavigation for functional mapping after aborted awake craniotomy. Surg Neurol Int 2016; 7:13. [PMID: 26958419 PMCID: PMC4766807 DOI: 10.4103/2152-7806.175885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/29/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Awake craniotomy is currently the gold standard for aggressive tumor resections in eloquent cortex. However, a significant subset of patients is unable to tolerate this procedure, particularly the very young or old or those with psychiatric comorbidities, cardiopulmonary comorbidities, or obesity, among other conditions. In these cases, typical alternative procedures include biopsy alone or subtotal resection, both of which are associated with diminished surgical outcomes. CASE DESCRIPTION Here, we report the successful use of a preoperatively obtained resting state functional connectivity magnetic resonance imaging (MRI) integrated with intraoperative neuronavigation software in order to perform functional cortical mapping in the setting of an aborted awake craniotomy due to loss of airway. CONCLUSION Resting state functional connectivity MRI integrated with intraoperative neuronavigation software can provide an alternative option for functional cortical mapping in the setting of an aborted awake craniotomy.
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Affiliation(s)
- Prag Batra
- Department of Computer Science, Washington University, St. Louis, Missouri, USA
| | - S Kathleen Bandt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University, St. Louis, Missouri, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
AbstractObjectives: Patients undergoing awake craniotomy may experience high levels of stress. Minimizing anxiety benefits patients and surgeons. Music has many therapeutic effects in altering human mood and emotion. Tonality of music as conveyed by composition in major or minor keys can have an impact on patients’ emotions and thoughts. Assessing the effects of listening to major and minor key musical pieces on patients undergoing awake craniotiomy could help in the design of interventions to alleviate anxiety, stress and tension. Methods: Twenty-nine patients who were undergoing awake craniotomy were recruited and randomly assigned into two groups: Group 1 subjects listened to major key music and Group 2 listened to minor key compositions. Subjects completed a demographics questionnaire, a pre- and post-operative Beck Anxiety Inventory (BAI) and a semi-structured open-ended interview. Results were analyzed using modified thematic analysis through open and axial coding. Results: Overall, patients enjoyed the music regardless of the key distinctions and stated they benefitted from listening to the music. No adverse reactions to the music were found. Subjects remarked that the music made them feel more at ease and less anxious before, during and after their procedure. Patients preferred either major key or minor key music but not a combination of both. Those who preferred major key pieces said it was on the basis of tonality while the individuals who selected minor key pieces stated that tempo of the music was the primary factor. Conclusion: Overall, listening to music selections was beneficial for the patients. Future work should further investigate the effects of audio interventions in awake surgery through narrative means.
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Kapsalakis IZ, Kapsalaki EZ, Gotsis ED, Verganelakis D, Toulas P, Hadjigeorgiou G, Chung I, Fezoulidis I, Papadimitriou A, Robinson JS, Lee GP, Fountas KN. Preoperative evaluation with FMRI of patients with intracranial gliomas. Radiol Res Pract 2012; 2012:727810. [PMID: 22848821 PMCID: PMC3403517 DOI: 10.1155/2012/727810] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/01/2012] [Accepted: 05/07/2012] [Indexed: 01/13/2023] Open
Abstract
Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI's accuracy by comparing it to intraoperative cortical stimulation (DCS) mapping. Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection. Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%. Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization.
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Affiliation(s)
- Ioannis Z. Kapsalakis
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Eftychia Z. Kapsalaki
- Department of Diagnostic Radiology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Efstathios D. Gotsis
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Dimitrios Verganelakis
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Panagiotis Toulas
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Indug Chung
- Departments of Neurosurgery and Intraoperative Electrophysiology, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, GA 31201, USA
| | - Ioannis Fezoulidis
- Department of Diagnostic Radiology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Alexandros Papadimitriou
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Joe Sam Robinson
- Departments of Neurosurgery and Intraoperative Electrophysiology, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, GA 31201, USA
| | - Gregory P. Lee
- Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA
| | - Kostas N. Fountas
- Department of Neurosurgery, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
- Institute of Biomedical Research and Technology (BIOMED), Center for Research and Technology-Thessaly (CERETETH), 38500 Larissa, Greece
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