1
|
Cossu G, Vandenbulcke A, Zaccarini S, Gaudet JG, Hottinger AF, Rimorini N, Potie A, Beaud V, Guerra-Lopez U, Daniel RT, Berna C, Messerer M. Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls. Cancers (Basel) 2024; 16:1784. [PMID: 38730736 PMCID: PMC11083963 DOI: 10.3390/cancers16091784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Awake craniotomy (AC) is recommended for the resection of tumors in eloquent areas. It is traditionally performed under monitored anesthesia care (MAC), which relies on hypnotics and opioids. Hypnosis-assisted AC (HAAC) is an emerging technique that aims to provide psychological support while reducing the need for pharmacological sedation and analgesia. We aimed to compare the characteristics and outcomes of patients who underwent AC under HAAC or MAC. METHODS We retrospectively analyzed the clinical, anesthetic, surgical, and neuropsychological data of patients who underwent awake surgical resection of eloquent brain tumors under HAAC or MAC. We used Mann-Whitney U tests, Wilcoxon signed-rank tests, and repeated-measures analyses of variance to identify statistically significant differences at the 0.05 level. RESULTS A total of 22 patients were analyzed, 14 in the HAAC group and 8 in the MAC group. Demographic, radiological, and surgical characteristics as well as postoperative outcomes were similar. Patients in the HAAC group received less remifentanil (p = 0.047) and propofol (p = 0.002), but more dexmedetomidine (p = 0.025). None of them received ketamine as a rescue analgesic. Although patients in the HAAC group experienced higher levels of perioperative pain (p < 0.05), they reported decreasing stress levels (p = 0.04) and greater levels of satisfaction (p = 0.02). CONCLUSION HAAC is a safe alternative to MAC as it reduces perioperative stress and increases overall satisfaction. Further research is necessary to assess whether hypnosis is clinically beneficial.
Collapse
Affiliation(s)
- Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland; (A.V.); (R.T.D.); (M.M.)
- L. Lundin and Family Brain Tumor Research Center, Departments of Oncology and Clinical Neurosciences, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
| | - Alberto Vandenbulcke
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland; (A.V.); (R.T.D.); (M.M.)
| | - Sonia Zaccarini
- Department of Anesthesiology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (S.Z.); (J.G.G.)
- Center for Integrative and Complementary Medicine, Department of Anesthesiology, University Hospital of Lausanne, The Sense and University of Lausanne, 1011 Lausanne, Switzerland; (N.R.); (C.B.)
| | - John G. Gaudet
- Department of Anesthesiology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (S.Z.); (J.G.G.)
| | - Andreas F. Hottinger
- L. Lundin and Family Brain Tumor Research Center, Departments of Oncology and Clinical Neurosciences, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
- Division of Neuro-oncology, Department of Oncology, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland
| | - Nina Rimorini
- Center for Integrative and Complementary Medicine, Department of Anesthesiology, University Hospital of Lausanne, The Sense and University of Lausanne, 1011 Lausanne, Switzerland; (N.R.); (C.B.)
| | - Arnaud Potie
- Department of Anesthesiology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (S.Z.); (J.G.G.)
| | - Valerie Beaud
- Service of Neuropsychology and Neurorehabilitation, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (V.B.); (U.G.-L.)
| | - Ursula Guerra-Lopez
- Service of Neuropsychology and Neurorehabilitation, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (V.B.); (U.G.-L.)
| | - Roy T. Daniel
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland; (A.V.); (R.T.D.); (M.M.)
- L. Lundin and Family Brain Tumor Research Center, Departments of Oncology and Clinical Neurosciences, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
| | - Chantal Berna
- Center for Integrative and Complementary Medicine, Department of Anesthesiology, University Hospital of Lausanne, The Sense and University of Lausanne, 1011 Lausanne, Switzerland; (N.R.); (C.B.)
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland; (A.V.); (R.T.D.); (M.M.)
- L. Lundin and Family Brain Tumor Research Center, Departments of Oncology and Clinical Neurosciences, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
| |
Collapse
|
2
|
Bala A, Olejnik A, Dziedzic T, Piwowarska J, Podgórska A, Marchel A. What helps patients to prepare for and cope during awake craniotomy? A prospective qualitative study. J Neuropsychol 2024; 18:30-46. [PMID: 37036087 DOI: 10.1111/jnp.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Abstract
There is growing interest in awake craniotomies, but some clinicians are concerned that such procedures are poorly tolerated by patients. Therefore, we conducted a study to assess this phenomenon. In this prospective qualitative study, 68 patients who qualified for awake craniotomy were asked to complete the Hospital Anxiety and Depression Scale (HADS)-two days before the surgery and visual analogue scales (VAS) for pain and stress, two days before the surgery and again about two days after. In addition, after their surgery, they took part in a structured interview about what helped them prepare for and cope with the surgery. Most patients tolerated the awake surgery well, scoring low on stress and pain scales. They reported a lower level of stress during the surgery (when questioned afterwards) than before it. Intensity of stress before the surgery correlated negatively with age, positively with HADS anxiety score and positively with stress subsequently experienced during surgery. The level of stress during surgery was associated with stress experienced before the surgery, pain and HADS anxiety and depression scores. Severity of pain during the surgery was positively correlated with stress during surgery and HADS depression and anxiety scores before the surgery. There was no correlation between stress, pain, anxiety and depression and the location of the lesion. Patients have a high tolerance for awake craniotomy. Various factors have an impact on how well patients cope with the operation. Extensive preoperative preparation should be considered a key part of the procedure.
Collapse
Affiliation(s)
| | | | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Piwowarska
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
3
|
Catalano Chiuvé S, Momjian S, Wolff A, Corniola MV. Effectiveness and reliability of hypnosis in stereotaxy: a randomized study. Acta Neurochir (Wien) 2024; 166:112. [PMID: 38411747 PMCID: PMC10899299 DOI: 10.1007/s00701-024-05943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) may experience pain during stereotactic frame (SF) fixation in deep brain stimulation (DBS). We assessed the role of hypnosis during the SF fixation in PD patients undergoing awake bilateral subthalamic nucleus (STN) DBS. METHODS N = 19 patients were included (N = 13 males, mean age 63 years; N = 10 allocated to the hypnosis and N = 9 allocated to the control groups). Patients were randomly assigned to the interventional (hypnosis and local anesthesia) or non-interventional (local anesthesia only) groups. The primary outcome was the pain perceived (the visual analogue scale (VAS)). Secondary outcomes were stress, anxiety, and depression, as measured by the perceived stress scale (PSS) and hospital anxiety and depression scale (HADS). Procedural distress was measured using the peritraumatic distress inventory (PDI-13). RESULTS In the hypnosis group, VASmean was 5.6 ± 2.1, versus 6.4 ± 1.2 in the control group (p = 0.31). Intervention and control groups reported similar VASmax scores (7.6 ± 2.1 versus 8.6 ± 1.6 (p = 0.28), respectively). Both groups had similar HADS scores (6.2 ± 4.3 versus 6.7 ± 1.92, p = 0.72 (HADSa) and 6.7 ± 4.2 versus 7.7 ± 3, p = 0.58 (HADSd)), so were the PSS scores (26.1 ± 6.3 versus 25.1 ± 7, p = 0.75). Evolutions of VASmean (R2 = 0.93, 95% CI [0.2245, 1.825], p = 0.03) and PDI-13 scores (R2 = 0.94, 95% CI [1.006, 6.279], p = 0.02) significantly differ over follow-up with patients in the hypnosis groups showing lower scores. CONCLUSION In this unblinded, randomized study, hypnosis does not influence pain, anxiety, and distress during awake SF fixation but modulates pain memory over time and may prevent the integration of awake painful procedures as a bad experience into the autobiographical memory of patients suffering from PD. A randomized controlled study with more data is necessary to confirm our findings.
Collapse
Affiliation(s)
- Sabina Catalano Chiuvé
- Neurology Department, Neuropsychology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, Université of Genève, Geneva, Suisse
- Neurosurgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Adriana Wolff
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
| | | |
Collapse
|
4
|
Bankole NDA, Kanmounye US, Ouahabi AE, Zemmoura I. Asleep-awake-asleep versus hypnosis for low-grade glioma surgery: long term follow-up outcome. Neurochirurgie 2023; 69:101494. [PMID: 37714375 DOI: 10.1016/j.neuchi.2023.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Hypnosis-aided craniotomy is a safe alternative to standard asleep-awake-asleep (AAA) surgery in glioma surgery. The impact of these two anesthetic methods on tumor prognosis has never been assessed. OBJECTIVE This study aimed to evaluate the possible impact of the type of sedation (i.e., hypnosedation vs. standard sedation) on postoperative outcomes in awake surgery for gliomas. METHODS Adult patients who underwent awake surgery for a diffuse glioma, excluding glioblastomas, between May 2011 and December 2019 at the authors' institution were included in the analysis. Pearson Chi-square, Fisher exact, and Mann-Whitney U tests were used for inferential analyses. RESULTS Sixty-one (61) patients were included, thirty-one were female (50.8 %), and the mean age was 41.8 years (SD = 11.88). Most patients had IDH mutated tumors (n = 51; 83.6%). Twenty-six patients (42.6%) were hypnosedated while 35 (57.4%) received standard AAA procedure. The overall median follow-up time was 48 months (range: 10 months-120 months). Our results did not identify any significant difference between both techniques in terms of extent of resection (sub-total resection >95% rates were 11.48% vs. 8.20%, OR = 2.2, 95% CI = 0.62-8.44; P = 0.34) and of overall survival (87.5% of patients in the AAA surgery group reach 9 years OS vs. 79% in the hypnosis cohort, cHR = 0.85, 95% CI = 0.12-6.04; P = 0.87). CONCLUSION Hypnosis for awake craniotomy is rarely proposed although it is a suitable alternative to standard sedation in awake craniotomy for LGGs, with similar results in terms of extent of resection or survival.
Collapse
Affiliation(s)
- Nourou Dine Adeniran Bankole
- CHRU de Tours, Neurosurgery Department, Tours, France; CHU Ibn Sina, Neurosurgery Department, Mohammed V University of Rabat, Morocco; Clinical Investigation Center (CIC), 1415, INSERM, CHRU de Tours, Tours, France.
| | | | | | - Ilyess Zemmoura
- CHRU de Tours, Neurosurgery Department, Tours, France; UMR Inserm U1253, iBrain, University of Tours, Tours, France.
| |
Collapse
|
5
|
Chen R, Chen Y, Yang M, Liu Y, Zhang X, Li J, Yang X, Liao Y, Du G, Cao X. Patients' caring experience during procedures under regional anesthesia in Mainland China: A phenomenology study. Heliyon 2023; 9:e20330. [PMID: 37810870 PMCID: PMC10556589 DOI: 10.1016/j.heliyon.2023.e20330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Although regional anesthesia is common, the procedure results in feelings of uncertainty and anxiety in some patients. Increased care is needed for these patients under general anesthesia. Few studies have focused on the intraoperative caring experience of patients during regional anesthesia. This study focused on the caring experience of patients during procedures involving regional anesthesia. Methods The descriptive phenomenology method of Husserl was employed. Semi-structured interviews were conducted with a purposive sample in five Grade III-A hospitals in Zhengzhou City, Henan Province. The seven-step analysis method of Colaizzi was applied for the analysis, summation, and theme refinement of the interview data. Results A total of 14 patients from five hospitals participated in the interviews. Four domains and 16 themes emerged during analysis: be informed (about the operation site, progression of the operation, informed in advance, receive explanation for abnormal experience); take care of my body (painless, gentle movements, special care); be protected (work seriously, favorable atmosphere, skilled, authority); and treated as an individual (pay attention, accompany, ask for opinions, encourage patient expression, humorous). Conclusion Patients during procedure under regional anesthesia had specific caring experiences relative to other patients. Medical staff should recognize the importance of regional anesthesia patients' intraoperative caring experience. Hospital administrators should offer support to allow healthcare staff to provide targeted caring for patients during procedure under regional anesthesia.
Collapse
Affiliation(s)
- Rui Chen
- Department of Infection Control, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, Fuzhou, China
| | - Ying Chen
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Meng Yang
- Department of Infection Control, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Yilan Liu
- Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinhui Zhang
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Jianlei Li
- Department of Knee Injuries, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Xue Yang
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Yufeng Liao
- School of Medical Technology and Nursing, Shenzhen Polytechnic, Shenzhen, Guangdong, China
| | - Guijuan Du
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Xiangyang Cao
- Department of Hospital President, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| |
Collapse
|
6
|
Zaccarini S, Fernandez A, Wolff A, Magnusson L, Rehberg-Klug B, Grape S, Schoettker P, Berna C. Hypnosis in the operating room: are anesthesiology teams interested and well-informed? BMC Anesthesiol 2023; 23:287. [PMID: 37620788 PMCID: PMC10464071 DOI: 10.1186/s12871-023-02229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff. DESIGN A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively. RESULTS Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training. CONCLUSION Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.
Collapse
Affiliation(s)
- Sonia Zaccarini
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Aurore Fernandez
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Adriana Wolff
- Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Lennart Magnusson
- Department of Anesthesiology, Cantons Hospital of Fribourg, Fribourg, Switzerland
| | - Benno Rehberg-Klug
- Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Sina Grape
- Department of Anesthesiology, Valais Hospital, Sion, Switzerland
| | - Patrick Schoettker
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Chantal Berna
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
7
|
Mofatteh M, Mashayekhi MS, Arfaie S, Chen Y, Hendi K, Kwan ATH, Honarvar F, Solgi A, Liao X, Ashkan K. Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review. Neurosurgery 2023; 92:225-240. [PMID: 36580643 DOI: 10.1227/neu.0000000000002224] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awake-awake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.
Collapse
Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | | | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Department of Molecular and Cell Biology, University of California Berkeley, California, USA
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Kasra Hendi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Faraz Honarvar
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Arad Solgi
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China.,Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| |
Collapse
|
8
|
Khu KJO, Pascual JSG, Ignacio KHD. Patient-reported intraoperative experiences during awake craniotomy for brain tumors: a scoping review. Neurosurg Rev 2022; 45:3093-3107. [PMID: 35816270 DOI: 10.1007/s10143-022-01833-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Awake craniotomy (AC) is a neurosurgical procedure that may be used to excise tumors located in eloquent areas of the brain. The techniques and outcomes of AC have been extensively described, but data on patient-reported experiences are not as well known. To determine these, we performed a scoping review of patient-reported intraoperative experiences during awake craniotomy for brain tumor resection. A total of 21 articles describing 534 patients were included in the review. Majority of the studies were performed on adult patients and utilized questionnaires and interviews. Some used additional qualitative methodology such as grounded theory and phenomenology. Most of the evaluation was performed within the first 2 weeks post-operatively. Recollection of the procedure ranged from 0 to 100%, and most memories dealt with the cranial fixation device application, cranial drilling, and intraoperative mapping. All patients reported some degree of pain and discomfort, mainly due to the cranial fixation device and uncomfortable operative position. Most patients were satisfied with their AC experience. They felt that participating in AC gave them a sense of control over their disease and thought that trust in the treatment team and adequate pre-operative preparation were very important. Patients who underwent AC for brain tumor resection had both positive and negative experiences intraoperatively, but overall, majority had a positive perception of and high levels of satisfaction with AC. Successful AC depends not only on a well-conducted intraoperative course, but also on adequate pre-operative information and patient preparation.
Collapse
Affiliation(s)
- Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, 1000, Ermita, Manila, Philippines.
| | - Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, 1000, Ermita, Manila, Philippines
| | - Katrina Hannah D Ignacio
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
9
|
Patchana T, Lopez JA, Majeed G, Ho A, Alarcon T, Plantak N, Vu P, Siddiqi J. The Awake Craniotomy: A Patient’s Experience and A Literature Review. Cureus 2022; 14:e26441. [PMID: 35915692 PMCID: PMC9338386 DOI: 10.7759/cureus.26441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
We present a case report and a literature review of the awake craniotomy procedure for mass resection, with emphasis on the historical aspects, anatomical and surgical considerations, and, uniquely, a patient’s experience undergoing this procedure. This procedure is a safe and effective method for lesion resection when working in and around eloquent brain. We have described our process of guiding a patient through an awake craniotomy procedure and detailed the patient's experience in this study. We also conducted a systematic literature review of studies involving awake craniotomy over three years, 2018-2021. Lastly, we compared the methodology used by our institution and the current mostly used methods within the neurosurgical community. Several studies were identified using PubMed and Google Scholar. Awake craniotomy is a safe and effective method of achieving a high rate of resection of lesions located in and around the eloquent cortex with a low degree of postoperative neurological deficit.
Collapse
|
10
|
Fang S, Liang Y, Li L, Wang L, Fan X, Wang Y, Jiang T. Tumor location-based classification of surgery-related language impairments in patients with glioma. J Neurooncol 2021; 155:143-152. [PMID: 34599481 DOI: 10.1007/s11060-021-03858-9] [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: 07/27/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Many patients with glioma experience surgery-related language impairment. This study developed a classification system to predict postoperative language prognosis. METHODS Sixty-eight patients were retrospectively reviewed. Based on their location, tumors were subtyped as follows: (I) inferior frontal lobe or precentral gyrus; (II) posterior central gyrus or supramarginal gyrus (above the lateral fissure level); (III) posterior region of the superior or middle temporal gyri or supramarginal gyrus (below the lateral fissure level); and (IV) insular lobe. The distance from the tumor to the superior longitudinal fasciculus/arcuate fasciculus was calculated. The recovery of language function was assessed using the Western Aphasia Battery before surgery, and a comprehensive language test was conducted on the day of surgery; 3, 7, and 14 days after surgery. Our follow-up information of was the comprehensive language test from telephone interviews in 3 months after surgery. RESULTS Thirty-three patients experienced transient language impairment within 1 week of surgery. Fourteen patients had permanent language impairment. Type II tumors, shorter distance from the tumor to the posterior superior longitudinal fasciculus/arcuate fasciculus, and isocitrate dehydrogenase mutations were risk factors for surgery-related language impairment. Regarding the presence or absence of permanent surgery-related language impairments, the cut-off distance between the tumor and posterior superior longitudinal fasciculus/arcuate fasciculus was 2.75 mm. CONCLUSIONS According to our classification, patients with type II tumors had the worst language prognosis and longest recovery time. Our classification, based on tumor location, can reliably predict postoperative language status and may be used to guide tumor resection.
Collapse
Affiliation(s)
- Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Yuchao Liang
- Beijing Neurosurgical Institute, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China.
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China.
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China.
- Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
11
|
Kamata K, Maruyama T, Komatsu R, Ozaki M. Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors. J Anesth 2021; 35:854-861. [PMID: 34402974 DOI: 10.1007/s00540-021-02990-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Intraoperative anxiety is the most common psychological response of the patient during awake craniotomy. Psychological stress can trigger patient decline, resulting in failed awake craniotomy and significantly poor outcomes. This study aimed to identify the risk factors for panic attack (PA) during awake craniotomies. METHODS With the local ethics committee approval, we conducted a manual chart review of the medical record of patients who underwent consecutive awake craniotomies between November 1999 and October 2016 at Tokyo Women's Medical University. A total of 405 patients were identified and assigned to 2 groups based on the Diagnostic and Statistical Manual of Mental Disorders-V criteria: those that met the PA criteria (Group PA) and those that did not (Group non-PA). Patient characteristics and the incidence of the PA specifier were collected. The features of the two groups were statistically compared, and risk factors for PA occurrence were determined by regression analysis. RESULTS Sixteen of 405 patients met the diagnostic criteria of PA. Patients' characteristics were not statistically different between the groups. Multivariate logistic regression showed that intraoperative anxiety (p = 0.0002) and age younger than 39 years (as opposed to age > = 39 years; p = 0.0328) were significantly associated with the occurrence of PA during awake craniotomy. CONCLUSIONS For patients undergoing awake craniotomy, intraoperative anxiety and age younger than 39 years were considered risk factors of PA. As PA often necessitates conversion to general anesthesia, intensive perioperative psychological support and pain management are required to achieve patient satisfaction and the surgical goal of awake craniotomy.
Collapse
Affiliation(s)
- Kotoe Kamata
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan. .,Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryu Komatsu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Primary Care Medicine, Nishiarai Hospital, Tokyo, Japan
| |
Collapse
|
12
|
Riou JB, Rouf CE, Moriniere S, Bakhos D, Lescanne E. Otosclerosis surgery under local anesthesia with sedation: Assessment of quality of life and stress. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:349-353. [PMID: 33741273 DOI: 10.1016/j.anorl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main study endpoint was tolerance of stapedotomy under local anesthesia with sedation and under general anesthesia using stress and quality of life assessment questionnaires. Secondary endpoints comprised operative time and functional results. MATERIAL AND METHOD In a consecutive series of stapedotomy patients operated on over a 12-month period, quality of life and perioperative stress were analysed by 3 questionnaires: the Glasgow Benefit Inventory, Cohen's perceived stress scale and the Post-traumatic stress disorder checklist scale. Questionnaire responses and audiometric data were compared between groups treated under local anesthesia with sedation and under general anesthesia. RESULTS Twenty-two patients were included in the local anesthesia with sedation group and 6 in the general anesthesia group. There was no difference between the groups for quality of life, onset of post-traumatic stress, or perceived pre- and postoperative stress. There was also no difference in operative time. The audiometric data confirmed the reliability of stapedotomy. Stapedotomy under local anesthesia with sedation improved air conduction with≤10dB air-bone gap (ABG), comparable to results under general anesthesia. The rate of ABG≤10dB was 71.4%; no labyrinthisation was observed. CONCLUSION Under local anesthesia with sedation, stapedotomy was well tolerated without increasing the stress associated with otosclerosis surgery. By correcting hearing loss, the procedure improves quality of life.
Collapse
Affiliation(s)
- J B Riou
- Service ORL et chirurgie cervicofaciale du CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Faculté de médecine de l'université de Tours, boulevard Tonnellé, 37000 Tours, France.
| | - C E Rouf
- Service ORL et chirurgie cervicofaciale du CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Moriniere
- Service ORL et chirurgie cervicofaciale du CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Faculté de médecine de l'université de Tours, boulevard Tonnellé, 37000 Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervicofaciale du CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Faculté de médecine de l'université de Tours, boulevard Tonnellé, 37000 Tours, France; INSERM 1253, iBrain, 37000 Tours, France
| | - E Lescanne
- Service ORL et chirurgie cervicofaciale du CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Faculté de médecine de l'université de Tours, boulevard Tonnellé, 37000 Tours, France
| |
Collapse
|
13
|
Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:2977-2990. [PMID: 33537890 PMCID: PMC8592967 DOI: 10.1007/s10143-021-01488-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 10/29/2022]
Abstract
Microsurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative MRI (IoMRI) for primary brain tumors, due to their multiple challenges. A systematic review of the literature was performed, in accordance with the Prisma guidelines. Were included 13 series and a total number of 527 patients, who underwent 541 surgeries. We paid particular attention to operative time, rate of intraoperative seizures, rate of initial complete resection at the time of first IoMRI, the final complete gross total resection (GTR, complete radiological resection rates), and the immediate and definitive postoperative neurological complications. The mean duration of surgery was 6.3 h (median 7.05, range 3.8-7.9). The intraoperative seizure rate was 3.7% (range 1.4-6; I^2 = 0%, P heterogeneity = 0.569, standard error = 0.012, p = 0.002). The intraoperative complete resection rate at the time of first IoMRI was 35.2% (range 25.7-44.7; I^2 = 66.73%, P heterogeneity = 0.004, standard error = 0.048, p < 0.001). The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8-52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). The GTR rate at discharge was 56.3% (range 47.5-65.1; I^2 = 60.19%, P heterogeneity = 0.01, standard error = 0.045, p < 0.001). The rate of immediate postoperative complications was 27.4% (range 15.2-39.6; I^2 = 92.62%, P heterogeneity < 0.001, standard error = 0.062, p < 0.001). The rate of permanent postoperative complications was 4.1% (range 1.3-6.9; I^2 = 38.52%, P heterogeneity = 0.123, standard error = 0.014, p = 0.004). Combined use of awake craniotomy and IoMRI can help in maximizing brain tumor resection in selected patients. The technical obstacles to doing so are not severe and can be managed by experienced neurosurgery and anesthesiology teams. The benefits of bringing these technologies to bear on patients with brain tumors in or near language areas are obvious. The lack of equipoise on this topic by experienced practitioners will make it difficult to do a prospective, randomized, clinical trial. In the opinion of the authors, such a trial would be unnecessary and would deprive some patients of the benefits of the best available methods for their tumor resections.
Collapse
|
14
|
Lubnin AY, Sinbukhova EV, Kulikov AS, Kobyakov GL. [Sensations of patients and their satisfaction during awake craniotomy]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:89-101. [PMID: 33095537 DOI: 10.17116/neiro20208405189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Awake craniotomy (AC) has gained fantastic popularity over the past years. This approach is no longer the destiny of only highly specialized neurosurgical centers. Technical features of AC are completely developed. However, certain aspects of patients' sensations and their satisfaction are still unclear. The review is devoted to these issues. It was shown that AC is positively evaluated by the vast majority of patients. Many patients would choose this technique for redo surgery. However, there are certain important details that can adversely affect satisfaction of patients. Thus, these features should be considered in AC.
Collapse
Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A S Kulikov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | |
Collapse
|
15
|
Reply to: Letter to the Editor Regarding Anesthesia Management for Low-Grade Glioma Awake Surgery: A European Low-Grade Glioma Network Survey. Acta Neurochir (Wien) 2020; 162:1723-1724. [PMID: 32388680 PMCID: PMC7211047 DOI: 10.1007/s00701-020-04371-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
|
16
|
Arzoine J, Levé C, Pérez-Hick A, Goodden J, Almairac F, Aubrun S, Gayat E, Freyschlag CF, Vallée F, Mandonnet E, Madadaki C. Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey. Acta Neurochir (Wien) 2020; 162:1701-1707. [PMID: 32128618 DOI: 10.1007/s00701-020-04274-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resection - during which the patient needs to be fully awake - and closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines. OBJECTIVE The objective of the survey was to explore differences and commonalities regarding the anesthetic management of awake DLGG surgery within the European Low-Grade Glioma Network (ELGGN) centers. METHODS A form that contained 14 questions about the anesthetic management was sent to 28 centers in May 2015. RESULTS Twenty centers responded. During the opening and closing non-awake periods, 56% of teams chose general anesthesia with mechanical ventilation for at least one period (asleep-awake-asleep, SAS protocol), and 44% monitored anesthesia care including sedation without mechanical ventilation (MAC protocol). In case of SAS, all the teams chose intravenous anesthesia, 82% used laryngeal mask instead of endotracheal intubation during the opening sequence, and 71% during closure. Local and regional anesthesia was practiced by all the teams. The most frequently reported cause of pain was dural and cerebral vessels manipulation (77%). Pain management was mostly based on paracetamol (70%) and remifentanil (55%). CONCLUSION Our survey showed that there was an equivalent proportion of centers using SAS or MAC protocols in the anesthetic management of awake surgery in ELGGN centers. The advantages and disadvantages of each anesthesia protocol were reviewed.
Collapse
Affiliation(s)
- Jeremy Arzoine
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
| | - Charlotte Levé
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
- INSERM UMR-942, Paris, France
| | | | - John Goodden
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Fabien Almairac
- Department of Neurosurgery, Hôpital Pasteur II, University Hospital of Nice, Nice, France
| | - Sylvie Aubrun
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
- University Paris 7, Paris, France
| | | | - Fabrice Vallée
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
- INSERM UMR-942, Paris, France
| | - Emmanuel Mandonnet
- University Paris 7, Paris, France.
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France.
- Frontlab, Institut du Cerveau et de la Moelle épinière, Inserm U 1127, CNRS UMR 7225, Paris, France.
| | - Catherine Madadaki
- Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France
| |
Collapse
|
17
|
Picart T, Guyotat J, Pardey Bracho GF. Letter to the editor regarding anesthesia management for low-grade glioma awake surgery: a European low-grade glioma network survey. Acta Neurochir (Wien) 2020; 162:1721-1722. [PMID: 32383015 DOI: 10.1007/s00701-020-04370-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 boulevard Pinel, 69667, Bron, France.
- Faculty of Medicine Lyon Est, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France.
- Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, 28 rue Laennec, 69008, Lyon, France.
| | - Jacques Guyotat
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 boulevard Pinel, 69667, Bron, France
| | - Gilda F Pardey Bracho
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 boulevard Pinel, 69667, Bron, France
| |
Collapse
|
18
|
Pesce A, Palmieri M, Cofano F, Iasanzaniro M, Angelini A, D'Andrea G, Monticelli M, Zeppa P, Santonio FV, Zenga F, Salvati M, Santoro A, Garbossa D, Frati A. Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial. J Clin Neurosci 2020; 77:41-48. [PMID: 32409219 DOI: 10.1016/j.jocn.2020.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023]
Abstract
Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.
Collapse
Affiliation(s)
| | - Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy.
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Iasanzaniro
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Albina Angelini
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Giancarlo D'Andrea
- Department of Neurosurgery, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Matteo Monticelli
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Filippo Veneziani Santonio
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Salvati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | | |
Collapse
|
19
|
Rouf CE, Bakhos D, Riou JB, Morinière S, Lescanne E. Otosclerosis surgery: Assessment of patient comfort. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:183-188. [DOI: 10.1016/j.anorl.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Cathey K, Gunyon N, Chung N, Conway N, Ames D, Singh M, Kassam AB, Rovin RA. A Feasibility Study of Lavender Aromatherapy in an Awake Craniotomy Environment. J Patient Cent Res Rev 2020; 7:19-30. [PMID: 32002444 PMCID: PMC6988712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Integrative medicine interventions are needed for awake craniotomies, as many patients experience anxiety. Lavender aromatherapy significantly reduces anxiety or pain in a variety of surgical procedures. This feasibility study used lavender aromatherapy during awake craniotomies to determine the number of patients who would consent and complete the study, the technicality of lavender aromatherapy use, and acceptance by operating room (OR) staff. METHODS We approached 40 consecutive patients (≥18 years old). Exclusion criteria were pulmonary issues or sensitivity to lavender. Outcome measures in consented patients were enrollment and completion rates, anxiety and pain as measured by the Visual Analog Scale for Anxiety (VAS-A) and Visual Analog Scale for Pain (VAS-P), and satisfaction with pain control using the Patient Opinion of Pain Management (POPM) survey. RESULTS Of the 40 patients approached, 4 declined participation or had their surgery cancelled. Of the remaining 36, 4 required increased sedation during surgery and 1 was unable to detect lavender. Thus, 31 patients (77.5%) completed the study. VAS-A and VAS-P scores trended lower after lavender inhalation, but the difference did not reach statistical significance. There was a slight increase in VAS-P score at the OR1 time point. Expectancy for reduction in both anxiety and pain were not significantly different. Improvement in anxiety also was not different, while improvement in pain trended lower (P=0.025). POPM results indicated the majority of patients were either "satisfied" or "very satisfied" with pain management. CONCLUSIONS This study demonstrated 77.5% completion and the ability to integrate lavender aromatherapy into the OR. Thus, we plan to conduct a randomized clinical trial to assess efficacy of lavender aromatherapy.
Collapse
Affiliation(s)
| | - Nichole Gunyon
- Aurora Neuroscience Innovation Institute, Aurora Health Care, Milwaukee, WI
| | - Nancy Chung
- Aurora Neuroscience Innovation Institute, Aurora Health Care, Milwaukee, WI
| | - Nancy Conway
- Integrative Medicine, Aurora Health Care, Milwaukee, WI
| | - Diane Ames
- Integrative Medicine, Aurora Health Care, Milwaukee, WI
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Amin B. Kassam
- Aurora Neuroscience Innovation Institute, Aurora Health Care, Milwaukee, WI
| | - Richard A. Rovin
- Aurora Neuroscience Innovation Institute, Aurora Health Care, Milwaukee, WI
| |
Collapse
|
21
|
Touzé AS, Fournier E, Laffon M, Morinière S. Primary hyperparathyroid surgery under local anaesthesia: benefits of hypnosis. Eur Arch Otorhinolaryngol 2019; 277:887-892. [PMID: 31807892 DOI: 10.1007/s00405-019-05754-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Minimally invasive parathyroid surgery and hypnosis are both increasing in prevalence. The objective of this study was to evaluate the efficacy of hypnoanalgesia compared with sedation during primary hyperparathyroid surgery under local anaesthesia. METHODS All patients who underwent primary hyperparathyroid surgery under local anaesthesia in our department between January 2013 and April 2018 were included retrospectively in two groups: patients operated under hypnoanalgesia (HYP group), and patients operated under sedation (LA group). The evaluation criteria were postoperative pain and analgesic consumption, amount of perioperative anti-emetics required, and length of hospital stay. RESULTS Thirty-six patients were included, 19 in the HYP group and 17 in the LA group. Postoperative pain levels and analgesic consumption rates were lower in the HYP group (numeric scale = 0.5/10 vs. 2.7/10, p = 0.0001; 11% vs. 47%, p = 4.9 × 10-8). Intraoperative anti-emetics delivery was lower in the HYP group (5% vs. 35%, p = 2.9 × 10-7). The ambulatory care rate was higher in the HYP group (74% vs. 59%, p = 0.03). CONCLUSION Local anaesthesia with hypnoanalgesia, compared with sedation during minimally invasive parathyroid surgery, improved early postoperative outcomes, making outpatient management more efficient.
Collapse
Affiliation(s)
- Anne-Solveig Touzé
- Service ORL Et Chirugie Cervico-Faciale, Centre Hospitalo-Universitaire de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Eric Fournier
- Service d'anesthésie-réanimation, Centre Hospitalo-Universitaire de Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Marc Laffon
- Service d'anesthésie-réanimation, Centre Hospitalo-Universitaire de Tours, 2 Boulevard Tonnellé, 37000, Tours, France.,Université François Rabelais, 10 Boulevard Tonnellé, 37000, Tours, France
| | - Sylvain Morinière
- Service ORL Et Chirugie Cervico-Faciale, Centre Hospitalo-Universitaire de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.,Université François Rabelais, 10 Boulevard Tonnellé, 37000, Tours, France
| |
Collapse
|
22
|
|
23
|
In Reply to the Letter to the Editor Regarding “Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience”. World Neurosurg 2019; 126:690-691. [DOI: 10.1016/j.wneu.2019.02.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 12/30/2022]
|
24
|
Pardey Bracho GF, Guyotat J, Picart T. Letter to the Editor Regarding "Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience". World Neurosurg 2019; 126:688-689. [PMID: 30682509 DOI: 10.1016/j.wneu.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Gilda F Pardey Bracho
- Department of Anesthesia and Critical Care, D. Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Bron, France.
| | - Jacques Guyotat
- Department of Neurosurgery, D. Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Bron, France
| | - Thiébaud Picart
- Department of Neurosurgery, D. Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Bron, France
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. RECENT FINDINGS Both approaches for anesthesia for awake craniotomy, asleep-awake-asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist. Dexmedetomidine has demonstrated high efficacy and safety in MAC for awake craniotomy and has become a rational alternative to propofol. Despite the high efficacy of scalp block and opioids, pain remains a common compliant in awake craniotomy. Appropriate surgical tactics can reduce pain and even prevent postoperative neurological complications. Although the efficacy of prophylaxis of intraoperative seizures with anticonvulsants remains doubtful, levetiracetam can be superior to other drugs for this purpose. SUMMARY Following a great deal of progress in anesthetic management, awake craniotomy, which had been a relatively rare approach, is now a commonly performed procedure for neurosurgical intervention. Modern anesthesia techniques can provide for successful brain mapping in almost any patient. Management of awake craniotomy in high-risk patients is a central task for future research.
Collapse
|
26
|
Chapet O, Udrescu C, Horn S, Ruffion A, Lorchel F, Gaudioz S, Clamens C, Piriou V, Rigal E. Prostate brachytherapy under hypnosedation: A prospective evaluation. Brachytherapy 2019; 18:22-28. [DOI: 10.1016/j.brachy.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
|
27
|
Frati A, Pesce A, Palmieri M, Iasanzaniro M, Familiari P, Angelini A, Salvati M, Rocco M, Raco A. Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience. World Neurosurg 2019; 121:e882-e891. [DOI: 10.1016/j.wneu.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022]
|
28
|
Gernsback JE, Kolcun JPG, Starke RM, Ivan ME, Komotar RJ. Who Needs Sleep? An Analysis of Patient Tolerance in Awake Craniotomy. World Neurosurg 2018; 118:e842-e848. [PMID: 30026153 DOI: 10.1016/j.wneu.2018.07.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Awake craniotomy (AC) is generally a safe and effective procedure; however, a small but not insignificant portion of cases are aborted due to patient intolerance of the awake portion of surgery. There is not yet a firm understanding of what characteristics indicate patient tolerance or failure of AC. METHODS We retrospectively reviewed a single-surgeon database of patients treated by AC over a 5-year period. Charts were reviewed for demographic, clinical, and operative characteristics, including anesthetic administration during the awake portion of surgery. Statistical analysis was performed to determine which factors predicted patient tolerance or failure. RESULTS Our study cohort comprised 120 patients with an average age of 56.0 ± 15.2 years. A majority of patients were male (55.8%). The most common surgical indication was tumor (95.8%), with gliobastoma as the most common diagnosis (43.3%). Male sex predicted surgical tolerance on univariate analysis (P = 0.015). Remifentanil administration was associated with surgical failure on univariate analysis (P = 0.068), and also predicted failure on multivariate analysis (P = 0.030). Preoperative seizure, ketamine administration, and right-sided surgery each predicted patient tolerance, but did not achieve statistical significance. Similarly, respiratory comorbidity was associated with surgical failure, but did not achieve significance. CONCLUSIONS AC remains an effective treatment option; the majority of patients tolerate the procedure without issue. Male patients have lower rates of surgical failure, whereas remifentanil administration may increase failure rate.
Collapse
Affiliation(s)
- Joanna E Gernsback
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John Paul G Kolcun
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
29
|
Quality and Quantity of Memories in Patients Who Undergo Awake Brain Tumor Resection. World Neurosurg 2017; 109:e258-e264. [PMID: 28987835 DOI: 10.1016/j.wneu.2017.09.158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Awake craniotomy is performed with increasing frequency for brain tumor surgery in eloquent areas; however, little is known about patients' memories of this procedure. Here we retrospectively analyzed the quality and quantity of memories in a series of patients treated following a standardized protocol. METHODS We treated 61 consecutive patients within 3 years, 48 of whom were alive when the study was performed. Each of these patients received a questionnaire eliciting information about their perioperative memories and perceptions. The perioperative process was broken down into steps, and for each step the patient was to judge the quantity (nothing-everything) and quality (very negative-very positive) of his or her memories. RESULTS Thirty-six of the 48 patients completed the questionnaire (75%). The quantity of memories was quite incomplete, even for intraoperative moments when patients were awake and cooperative. On average, the quality of memories was neutral or positive. A higher quantity of memories was associated with a higher quality of memories. The most commonly reported sources of discomfort were placement of the Mayfield clamp, followed by laying on the operating room table with movement restriction, and irritation by the urinary catheter in situ. CONCLUSIONS Awake craniotomy can be performed following our protocol in such a way that it is experienced as (very) comfortable. However, there are moments of discomfort, which can be managed by the team. Extensive preoperative preparation may be considered a crucial part of the procedure. Less amnesia seems to improve patient satisfaction. The results of this study can help guide protocol optimization, expectation management, and information for future patients.
Collapse
|
30
|
Survey on current cognitive practices within the European Low-Grade Glioma Network: towards a European assessment protocol. Acta Neurochir (Wien) 2017; 159:1167-1178. [PMID: 28474122 DOI: 10.1007/s00701-017-3192-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The European Low-Grade Glioma network indicated a need to better understand common practices regarding the managing of diffuse low-grade gliomas. This area has experienced great advances in recent years. METHOD A general survey on the managing of diffuse low-grade gliomas was answered by 21 centres in 11 European countries. Here we focused on specific questions regarding perioperative and intraoperative cognitive assessments. RESULTS More centres referred to the same speech and language therapist and/or neuropsychologist across all assessments; a core of assessment tools was routinely used across centres; fluency tasks were commonly used in the perioperative stages, and object naming during surgery; tasks that tapped on attention, executive functions, visuospatial awareness, calculation and emotions were sparsely administered; preoperative assessments were performed 1 month or 1 week before surgery; timing for postoperative assessments varied; finally, more centres recommended early rehabilitation, whenever needed. CONCLUSIONS There is an emerging trend towards following similar practices for the management of low-grade gliomas in Europe. Our results are descriptive and formalise current discussions in our group. Also, they contribute towards the development of a European assessment protocol.
Collapse
|
31
|
Fontaine D, Almairac F. Pain during awake craniotomy for brain tumor resection. Incidence, causes, consequences and management. Neurochirurgie 2017; 63:204-207. [DOI: 10.1016/j.neuchi.2016.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
|
32
|
Riquin E, Dinomais M, Malka J, Lehousse T, Duverger P, Menei P, Delion M. Psychiatric and Psychologic Impact of Surgery While Awake in Children for Resection of Brain Tumors. World Neurosurg 2017; 102:400-405. [PMID: 28300707 DOI: 10.1016/j.wneu.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population. OBJECTIVE The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients. METHODS Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated. RESULTS None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress. CONCLUSIONS The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.
Collapse
Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France.
| | - Mickael Dinomais
- Physical and Rehabilitation Medicine, University Hospital of Angers, Angers, France
| | - Jean Malka
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Thierry Lehousse
- Department of Anesthesiology, University Hospital of Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Philippe Menei
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | - Matthieu Delion
- Department of Neurosurgery, University Hospital of Angers, Angers, France; Anatomy Laboratory, LUNAM, University of Angers, Angers, France
| |
Collapse
|
33
|
Srairi M, Mrozek S, Roux F, Geeraerts T. Letter: Hypnosis for Awake Surgery of Low-Grade Gliomas: Description of the Method and Psychological Assessment. Neurosurgery 2017; 80:E186. [PMID: 28173575 DOI: 10.1093/neuros/nyw065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohamed Srairi
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Ségolène Mrozek
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Franck Roux
- Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesia and Intensive Care, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
34
|
Hansen E, Zech N, Doenitz C. Letter: Hypnosis for Awake Surgery of Low-Grade Gliomas: Description of the Method and Psychological Assessment. Neurosurgery 2017; 80:E187. [DOI: 10.1093/neuros/nyw044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
Madriz-Godoy M, Trejo-Gallegos S. Anaesthetic technique during awake craniotomy. Case report and literature review. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|