BACKGROUND: Gross total removal of glioma is limited by proximity to eloquent brain. Awake surgery allows for intraoperative monitoring to safely identify eloquent regions. However, data on adverse psychological effects induced in these patients is limited. OBJECTIVE: This study explored patients' perception of awake surgery for glioma, with special focus on intraoperative pain and anxiety. METHODS: This study was conducted at five neurosurgical centers within the European Low Grade Glioma Network. Patients underwent awake surgery for glioma according to the protocol of the individual center. Pain and discomfort were measured during the awake phase. Postoperatively, patients answered a questionnaire on aspects of their operation. RESULTS: One hundred five patients were enrolled. Pain levels on a 10-cm visual analogue scale were 1.3 cm at the beginning, 1.9 cm the middle, and 2.1 cm at the end of awake phase. Levels of anxiety were 2.2 cm, 2.5 cm and 2.6 cm, respectively. Women and patients younger than 60 years exhibited highest mean anxiety levels. The patient questionnaire revealed that the majority of patients feel comfortable with the procedure. Discomfort resulted from head fixation or positioning on the operating table. CONCLUSIONS: We demonstrate that awake surgery is well tolerated, as neither intraoperative nor postoperative assessment revealed major disadvantages. Concerning practical lessons learned from this study, we emphasize the importance of minimizing pain and preparing patients thoroughly to reduce anxiety and maximize cooperation. Awake surgery is an excellent treatment modality for brain tumors with very positive perception by patients.
BACKGROUND: Gross total removal of glioma is limited by proximity to eloquent brain. Awake surgery allows for intraoperative monitoring to safely identify eloquent regions. However, data on adverse psychological effects induced in these patients is limited. OBJECTIVE: This study explored patients' perception of awake surgery for glioma, with special focus on intraoperative pain and anxiety. METHODS: This study was conducted at five neurosurgical centers within the European Low Grade Glioma Network. Patients underwent awake surgery for glioma according to the protocol of the individual center. Pain and discomfort were measured during the awake phase. Postoperatively, patients answered a questionnaire on aspects of their operation. RESULTS: One hundred five patients were enrolled. Pain levels on a 10-cm visual analogue scale were 1.3 cm at the beginning, 1.9 cm the middle, and 2.1 cm at the end of awake phase. Levels of anxiety were 2.2 cm, 2.5 cm and 2.6 cm, respectively. Women and patients younger than 60 years exhibited highest mean anxiety levels. The patient questionnaire revealed that the majority of patients feel comfortable with the procedure. Discomfort resulted from head fixation or positioning on the operating table. CONCLUSIONS: We demonstrate that awake surgery is well tolerated, as neither intraoperative nor postoperative assessment revealed major disadvantages. Concerning practical lessons learned from this study, we emphasize the importance of minimizing pain and preparing patients thoroughly to reduce anxiety and maximize cooperation. Awake surgery is an excellent treatment modality for brain tumors with very positive perception by patients.
Authors: Giannantonio Spena; Philippe Schucht; Kathleen Seidel; Geert-Jan Rutten; Christian Franz Freyschlag; Federico D'Agata; Emanule Costi; Francesca Zappa; Marco Fontanella; Denys Fontaine; Fabien Almairac; Michele Cavallo; Pasquale De Bonis; Gerardo Conesa; Nicholas Foroglou; Santiago Gil-Robles; Emanuel Mandonnet; Juan Martino; Thomas Picht; Catarina Viegas; Michel Wager; Johan Pallud Journal: Neurosurg Rev Date: 2016-08-01 Impact factor: 3.042
Authors: Emmanuel Mandonnet; Michel Wager; Fabien Almairac; Marie-Helene Baron; Marie Blonski; Christian F Freyschlag; Fabio Barone; Denys Fontaine; Johan Pallud; Monika Hegi; Catarina Viegas; Maria Zetterling; Giannantonio Spena; John Goodden; Geert-Jan Rutten; Luc Taillandier; Nicolas Foroglu; Amélie Darlix; Miran Skrap; Juan Martino; Gord von Campe; Caterina Madadaki; Etienne Gayat; Philip de Witt Hamer; Santiago Gil Robles; Silvio Sarubbo; Thomas Santarius; Lorenzo Bello; Marie-Therese Forster; Hugues Duffau Journal: Neurooncol Pract Date: 2017-01-17