Psychological aspects of awake brain surgery in children—interests and risks

Huguet, Ludivine; Lohkamp, Laura-Nanna; Beuriat, Pierre-Aurélien; Desmurget, Michel; Bapteste, Lionel; Szathmari, A.; Mottolèse, C.; Rocco, Federico Di

doi:10.1007/s00381-019-04308-8

Cited by 14 publications

(30 citation statements)

References 34 publications

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“…Another possible cause of uncooperative behavior is the lack of sufficient confidence in the medical team, an aspect highlighted by Huguet et al. ( 32 ) and by Hejrati et al. ( 53 ), which pointed out the importance of sensible management of the patient and relatives.…”

Section: Discussionmentioning

confidence: 99%

“…Another well-established exclusion criterion is the presence of psychiatric diseases such as psychotic or personality disorders, obsessive-compulsive disorder and depression ( 32 , 46 , 52 , 96 ). These elements can be assessed through the anamnestic recollection but, in case of doubts, specific questionnaires or scales can also be administered.…”

Section: Discussionmentioning

confidence: 99%

“…Emotional lability and alexithymia were also considered as possible exclusion criteria ( 32 , 38 , 48 , 57 , 65 ) as well as confusion, disorientation and developmental delay, due to the consequent inability to understand the surgical procedure and cooperate during it ( 25 , 35 , 37 , 57 , 66 ).…”

Section: Discussionmentioning

confidence: 99%

“…Inability to cooperate may be due to several reasons, from disorganized or apathetic behaviors to cognitive deficits or personality structure issues (6,34). Another possible cause of uncooperative behavior is the lack of sufficient confidence in the medical team, an aspect highlighted by Huguet et al (32) and by Hejrati et al ( 53), which pointed out the importance of sensible management of the patient and relatives. In this regard, the level of motivation is another considered psychological aspect (32); it should not be underestimated the attention dedicated by clinicians to this issue and the need for thorough and comprehensive explanations to the patient and relatives.…”

Section: Eligibility Criteria For As -Exclusion Criteria 421 Psycholo...mentioning

confidence: 99%

“…Another possible cause of uncooperative behavior is the lack of sufficient confidence in the medical team, an aspect highlighted by Huguet et al (32) and by Hejrati et al ( 53), which pointed out the importance of sensible management of the patient and relatives. In this regard, the level of motivation is another considered psychological aspect (32); it should not be underestimated the attention dedicated by clinicians to this issue and the need for thorough and comprehensive explanations to the patient and relatives. In the authors' experience, a strong bond between the surgical team and the patient and its family increases motivation and facilitates positive cooperation with AS, while helping the patient to cope with anxiety and fear of surgery, especially in the intraoperative awake scenario.…”

Section: Eligibility Criteria For As -Exclusion Criteria 421 Psycholo...mentioning

confidence: 99%

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Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective

et al. 2022

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BackgroundAwake surgery (AS) permits intraoperative mapping of cognitive and motor functions, allowing neurosurgeons to tailor the resection according to patient functional boundaries thus preserving long-term patient integrity and maximizing extent of resection. Given the increased risks of the awake scenario, the growing importance of AS in surgical practice favored the debate about patient selection concerning both indication and eligibility criteria. Nonetheless, a systematic investigation is lacking in the literature.ObjectiveTo provide a scoping review of the literature concerning indication and eligibility criteria for AS in patients with gliomas to answer the questions:1) "What are the functions mostly tested during AS protocols?" and 2) "When and why should a patient be excluded from AS?".Materials and methodsPertinent studies were retrieved from PubMed, PsycArticles and Cochrane Central Register of Controlled Trials (CENTRAL), published until April 2021 according to the PRISMA Statement Extension for Scoping Reviews. The retrieved abstracts were checked for the following features being clearly stated: 1) the population described as being composed of glioma(LGG or HGG) patients; 2) the paper had to declare which cognitive or sensorimotor function was tested, or 2bis)the decisional process of inclusion/exclusion for AS had to be described from at least one of the following perspectives: neurosurgical, neurophysiological, anesthesiologic and psychological/neuropsychological.ResultsOne hundred and seventy-eight studies stated the functions being tested on 8004 patients. Language is the main indication for AS, even if tasks and stimulation techniques changed over the years. It is followed by monitoring of sensorimotor and visuospatial pathways. This review demonstrated an increasing interest in addressing other superior cognitive functions, such as executive functions and emotions. Forty-five studies on 2645 glioma patients stated the inclusion/exclusion criteria for AS eligibility. Inability to cooperate due to psychological disorder(i.e. anxiety),severe language deficits and other medical conditions(i.e.cardiovascular diseases, obesity, etc.)are widely reported as exclusion criteria for AS. However, a very few papers gave scale exact cut-off. Likewise, age and tumor histology are not standardized parameters for patient selection.ConclusionGiven the broad spectrum of functions that might be safely and effectively monitored via AS, neurosurgeons and their teams should tailor intraoperative testing on patient needs and background as well as on tumor location and features. Whenever the aforementioned exclusion criteria are not fulfilled, AS should be strongly considered for glioma patients.

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Section: Discussionmentioning

confidence: 99%