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Starowicz-Filip A, Prochwicz K, Myszka A, Krzyżewski R, Stachura K, Chrobak AA, Rajtar-Zembaty AM, Bętkowska-Korpała B, Kwinta B. Subjective experience, cognitive functioning and trauma level of patients undergoing awake craniotomy due to brain tumor - Preliminary study. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:983-992. [PMID: 33096001 DOI: 10.1080/23279095.2020.1831500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKUP AND OBJECTIVE Awake craniotomy (AC) for brain tumors, when the patient is conscious during the operation, allows to reduce the risk of motor disability and aphasia, however, it may be a source of extreme stress. The aim of our study was to examine the patients' subjective experience of the surgery including the level of psychological trauma and cognitive functioning. METHOD Eighteen patients operated due to brain tumor were enrolled in this study. The Essener Trauma-Inventory Questionnaire and the Addenbrooke's Cognitive Examination (ACE III) were administrated. The patients' experience with awake craniotomy was evaluated with a qualitative descriptive survey. RESULTS All patients remembered the intraoperative neuropsychological examination and several sensations like: drilling, cold, head clamp fixation or having eyes covered. In most of the patients the postoperative psychological trauma experience did not reach the clinical level. The ACE III postoperative scores revealed partial cognitive deficits with the lowest scores in memory and word fluency domains. Slight amnestic aphasia was observed postoperatively only in two patients. CONCLUSIONS Awake craniotomy for resection of brain tumors is well-tolerated by patients and does not cause significant psychological trauma. Nonetheless, anxiety about the procedure warrants further study and individualized neuropsychological care is needed for the emotional preparation of the patient.
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Affiliation(s)
- Anna Starowicz-Filip
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | - Aneta Myszka
- Jagiellonian University Medical College, Krakow, Poland
| | - Roger Krzyżewski
- Department of Neurosurgery, Jagiellonian University Medical College, Krakow, Poland
| | | | | | | | | | - Borys Kwinta
- Department of Neurosurgery, Jagiellonian University Medical College, Krakow, Poland
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Day J, Gillespie DC, Rooney AG, Bulbeck HJ, Zienius K, Boele F, Grant R. Neurocognitive Deficits and Neurocognitive Rehabilitation in Adult Brain Tumors. Curr Treat Options Neurol 2016; 18:22. [PMID: 27044316 DOI: 10.1007/s11940-016-0406-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Neurocognitive deficits are common with brain tumors. If assessed at presentation using detailed neurocognitive tests, problems are detected in 80 % of cases. Neurocognition may be affected by the tumor, its treatment, associated medication, mood, fatigue, and insomnia. Interpretation of neurocognitive problems should be considered in the context of these factors. Early post-operative neurocognitive rehabilitation for brain tumor patients will produce rehabilitation outcomes (e.g., quality of life, improved physical function, subjective neurocognition) equivalent to stroke, multiple sclerosis, and head injury, but the effect size and duration of benefit needs further research. In stable patients treated with radiotherapy +/- chemotherapy, the most frequent causes of distress include neurocognitive problems, psychological factors of anxiety, depression, fatigue, and sleep. Exercise, neurocognitive training, neurocognitive behavioral therapy, and medications to treat fatigue, behavior, memory, mood, and removal of drugs that may be associated with neurocognitive side effects (e.g., anti-epileptic drugs) all show promise in helping patients to manage the effects of their neurocognitive impairments better. As these are complex symptoms, multidisciplinary expertise is necessary to evaluate the influence of each variable to plan appropriate support and intervention. Neurocognitive rehabilitation should therefore occur in parallel with disease-centered, medical management from the outset. It should not occur in series, as a restricted phase in a patient's pathway. It should be considered in the pre- and post-operative period where there are good prospects of recovery, as one would for any brain-injured patient, so that the person may reach their optimal physical, sensory, intellectual, psychological, and social functional level. Yet the identification and selection of patients for early neurological rehabilitation and routine evaluation of cognition is uncommon in neurosurgical wards.
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Affiliation(s)
- Julia Day
- Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - David C Gillespie
- Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, Scotland, UK
| | - Helen J Bulbeck
- Brainstrust (the brain cancer people), Yvery Court, Castle Road, Cowes, Isle of Wight, PO31 7QG, UK
| | - Karolis Zienius
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Florien Boele
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
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