Kerrigan S, Dengu F, Erridge S, Grant R, Whittle I R
Department of Clinical Neurosciences and Radiation Oncology, University of Edinburgh, Western General Hospital, Edinburgh, UK.
Br J Neurosurg. 2012 Feb;26(1):28-31. doi: 10.3109/02688697.2011.594187. Epub 2011 Aug 4.
Many patients with intracranial tumours have cognitive deficits that might affect their mental capacity to give valid consent to neurosurgical treatment. The aim of this study was to determine the incidence of mental incapacity, as assessed by neurosurgeons, in patients with intracranial tumours undergoing neurosurgery.
The case notes of successive patients undergoing brain tumour surgery between 16 October 2008 and 16 October 2010 were reviewed. The frequency of use of standard consent forms and Certificates of Incapacity was recorded. In addition, the frequency and scores of pre-operative cognitive assessments were recorded.
Case notes of 247 of 262 patients undergoing surgery for intracranial tumours were reviewed since there was no record of either a standard consent form or a Certificate of Incapacity in the case notes for 15 patients. Nine of 247 brain tumour patients were issued with a Certificate of Incapacity (3.6%, 95% CI 1.6-6.8%), while 238 (96.4%) signed a standard consent form. Seven of these nine had high-grade gliomas, for an incidence of incapacity of 5.9% (95% CI 2.8-11.8%), while the remaining two Certificates of Incapacity were issued for patients with meningiomas (incidence 3%; 95% CI 0.04-10.4%). Fifty of the 262 patients (19%) had some form of pre-operative cognitive assessment documented, but only three of these were issued with a Certificate of Incapacity. All three patients issued with a Certificate of Incapacity had Mini-Mental State Examination scores suggestive of cognitive impairment.
Incapacity to consent to brain tumour surgery, as assessed by neurosurgeons, is uncommon. The incidence of incapacity is less than might be expected given the level of cognitive impairment known in this population. Decisions about capacity by neurosurgeons are often made in the absence of any documented assessment of cognition or other objective evidence that could support their decision in the event of dispute.
许多颅内肿瘤患者存在认知缺陷，这可能会影响他们对神经外科治疗给予有效同意的心理能力。本研究的目的是确定神经外科医生评估的颅内肿瘤患者接受神经外科手术时无行为能力的发生率。
回顾了2008年10月16日至2010年10月16日期间连续接受脑肿瘤手术患者的病历。记录了标准同意书和无行为能力证明的使用频率。此外，记录了术前认知评估的频率和分数。
由于15例患者的病历中没有标准同意书或无行为能力证明的记录，因此对262例接受颅内肿瘤手术患者中的247例病历进行了回顾。247例脑肿瘤患者中有9例被出具了无行为能力证明（3.6%，95%可信区间1.6 - 6.8%），而238例（96.4%）签署了标准同意书。这9例中的7例患有高级别胶质瘤，无行为能力发生率为5.9%（95%可信区间2.8 - 11.8%），其余两份无行为能力证明是为患有脑膜瘤的患者出具的（发生率3%；95%可信区间0.04 - 10.4%）。262例患者中有50例（19%）有某种形式的术前认知评估记录，但其中只有3例被出具了无行为能力证明。所有3例被出具无行为能力证明的患者简易精神状态检查表得分提示认知障碍。
经神经外科医生评估，无法同意进行脑肿瘤手术的情况并不常见。考虑到该人群已知的认知障碍水平，无行为能力的发生率低于预期。神经外科医生关于行为能力的决定通常是在没有任何记录在案的认知评估或其他客观证据的情况下做出的，而这些证据在发生争议时可能支持他们的决定。
