Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Preoperative Anesthetic Management
2.2. Intraoperative Anesthetic and Surgical Procedures
2.3. Specificities of HAAC Technique
2.4. Specificities of MAC Technique
2.5. Postoperative Management, Neuropsychological Tests, and Periprocedural Questionnaires
- -
- -
- a Visual Analog Scale (VAS) was used to quantify stress, comfort, and pain preoperatively, during surgery, and at the end of the procedure;
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- the Impact of Events Scale-Revised (IES-R) [39], the Peritraumatic Distress Inventory (PDI) [40], and the Peritraumatic Dissociation Experiences Questionnaire (PDEQ) [41] were used 3 to 7 days after the procedure to retrospectively assess the psychological impact and level of dissociation at the time of surgery;
- -
- a series of 19 questions designed by our team to assess the level of satisfaction with surgical, anesthetic, and neuropsychological management, identify painful memories during the surgical procedure, test orientation in time and space, and establish whether patients would undergo a second surgery under similar conditions (Supplementary file S1).
2.6. Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | HAAC Cohort (14 Patients) | MAC Cohort (8 Patients) | p-Value |
---|---|---|---|
Mean age +/− SD | 42.7 years +/− 9.3 | 49.9 years +/− 11.1 | 0.12 |
Women | 7 (50%) | 4 (50%) | 1 |
Tumor localization:
Left hemisphere | 8 1 1 1 2 1 12 | 2 1 3 2 0 0 8 | 0.17 1 0.11 0.53 0.51 1 0.51 |
Diagnosis:
| 7 2 3 2 | 2 1 5 0 | 0.38 1 0.08 0.51 |
Recurrent tumor
| 4 (28.6%) 1/4 | 3 (37.5%) 3/3 | 0.67 0.14 |
Median KPS +/− IQR | 100 +/− 10 | 90 +/− 10 | 0.6 |
Complete resection | 9 (64.3%) | 4 (50%) | 0.66 |
Tumor volume +/− SD | 38.7 cm3 +/− 40.2 | 60.6 cm3 +/− 68.3 | 0.43 |
Mean length of the surgical procedure (with anesthesia time) +/− SD | 291 min, +/− 59 | 352 min, +/− 75 | 0.06 |
Surgery time +/− SD | 196 min +/− 46.2 | 246 min +/− 74.6 | 0.08 |
Anesthesia time +/− SD | 43 min +/− 32.5 | 57.7 min +/− 7.8 | 0.25 |
Intraoperative events:
| 0 2 (14.3%) | 0 0 | 1 0.25 |
Variable | HAAC Cohort | MAC Cohort | p-Value |
---|---|---|---|
Analgesia
| 436 mcg, +/− 205 0.029 mcg/kg/min +/− 0.013 210 min, +/− 88 7/14 0/14 7/14 | 659 mcg, +/− 289 0.026 mcg/kg/min +/− 0.006 288min, +/− 89 8/8 8/8 4/8 | 0.047 0.63 0.059 0.02 <0.00001 1 |
Hypnotics
| 4/14 96.2 mcg, +/− 85.5 1.3 mcg/kg; +/− 1.2 7/14 93 mcg, +/− 53 0.71 mcg/kg/h, +/− 0.3 | 8/8 1238 mcg, +/− 346 14.8 mcg/kg, +/− 5.3 4/8 128 mcg, +/− 54 0.31 mcg/kg/h, +/− 0.1 | 0.002 0.00008 <0.0001 1 0.32 0.025 |
Noradrenaline | 0/14 | 4/8 | 0.0017 |
Variable | HAAC Cohort | MAC Cohort | p-Value |
---|---|---|---|
Preoperative depression confirmed at HADS Preoperative anxiety confirmed at HADS | 2/11 (18%) 7/11 (63.6%) | 0/7 (0%) 2/7 (28.6%) | 0.52 0.33 |
High perceived stress preoperatively (PSS) Mean VAS for preoperative stress +/− SD Mean VAS for perioperative stress +/− SD Mean VAS for postoperative stress +/− SD | 0/10 (0%) 5.8 +/− 2.8 5.4 +/− 3.01 3.54 +/− 2.44 | 1/6 (17%) 3 +/− 2.83 2.7 +/− 2.8 5.2 +/− 1.72 | 0.37 0.09 0.09 0.15 |
Mean perioperative pain (mean +/− SD) Maximal perioperative pain (mean +/− SD) | 3.8 +/− 2.32 7.25 +/− 2.8 | 0.9 +/− 1.52 2.7 +/− 2.86 | 0.03 0.009 |
Mean perioperative discomfort (mean +/− SD) | 4.9 +/− 3.2 | 3.6 +/− 3.8 | 0.5 |
Posttraumatic events distress: Pathological IES-R Pathological PDI Pathological PDEQ | 3/10 (30%) 1/10 (10%) 6/10 (60%) | 0/7 (0%) 2/8 (25%) 4/8 (50%) | 0.2 0.5 0.7 |
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Share and Cite
Cossu, G.; Vandenbulcke, A.; Zaccarini, S.; Gaudet, J.G.; Hottinger, A.F.; Rimorini, N.; Potie, A.; Beaud, V.; Guerra-Lopez, U.; Daniel, R.T.; et al. Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls. Cancers 2024, 16, 1784. https://doi.org/10.3390/cancers16091784
Cossu G, Vandenbulcke A, Zaccarini S, Gaudet JG, Hottinger AF, Rimorini N, Potie A, Beaud V, Guerra-Lopez U, Daniel RT, et al. Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls. Cancers. 2024; 16(9):1784. https://doi.org/10.3390/cancers16091784
Chicago/Turabian StyleCossu, Giulia, Alberto Vandenbulcke, Sonia Zaccarini, John G. Gaudet, Andreas F. Hottinger, Nina Rimorini, Arnaud Potie, Valerie Beaud, Ursula Guerra-Lopez, Roy T. Daniel, and et al. 2024. "Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls" Cancers 16, no. 9: 1784. https://doi.org/10.3390/cancers16091784