Leal Rafael Teixeira Magalhaes, da Fonseca Clovis Orlando, Landeiro Jose Alberto
Departamento de Neurocirurgia, Hospital Universitario Antonio Pedro, Universidade Federal Fluminense, Rua Marques de Parana, 303, 3o andar, 24033-900, Niteroi, Rio de Janeiro, Brazil.
Acta Neurochir (Wien). 2017 Apr;159(4):725-731. doi: 10.1007/s00701-017-3125-0. Epub 2017 Feb 28.
Awake craniotomy with brain mapping is the gold standard for eloquent tissue localization. Patients' tolerability and satisfaction have been shown to be high; however, it is a matter of debate whether these findings could be generalized, since patients across the globe have their own cultural backgrounds and may perceive and accept this procedure differently.
We conducted a prospective qualitative study about the perception and tolerability of awake craniotomy in a population of consecutive brain tumor patients in Brazil between January 2013 and April 2015. Seventeen patients were interviewed using a semi-structured model with open-ended questions.
Patients' thoughts were grouped into five categories: (1) overall perception: no patient considered awake craniotomy a bad experience, and most understood the rationale behind it. They were positively surprised with the surgery; (2) memory: varied from nothing to the entire surgery; (3) negative sensations: in general, it was painless and comfortable. Remarks concerning discomfort on the operating table were made; (4) postoperative recovery: perception of the postoperative period was positive; (5) previous surgical experiences versus awake craniotomy: patients often preferred awake surgery over other surgery under general anesthesia, including craniotomies.
Awake craniotomy for brain tumors was well tolerated and yielded high levels of satisfaction in a population of patients in Brazil. This technique should not be avoided under the pretext of compromising patients' well-being.
术中唤醒开颅术结合脑图谱是明确功能区脑组织定位的金标准。研究表明患者对此的耐受性和满意度较高；然而，这些结果是否具有普遍性仍存在争议，因为全球各地的患者有着不同的文化背景，对该手术的认知和接受程度可能有所差异。
2013年1月至2015年4月期间，我们对巴西连续收治的脑肿瘤患者群体进行了一项关于术中唤醒开颅术认知和耐受性的前瞻性定性研究。采用半结构化模型及开放式问题对17名患者进行了访谈。
患者的想法分为五类：（1）总体认知：没有患者认为术中唤醒开颅术是一次糟糕的经历，大多数患者理解其背后的原理。他们对手术感到惊喜；（2）记忆：从毫无记忆到记得整个手术过程不等；（3）负面感受：总体而言，手术无痛且舒适。有患者提到在手术台上感到不适；（4）术后恢复：对术后阶段的认知是积极的；（5）既往手术经历与术中唤醒开颅术对比：与包括开颅术在内的其他全身麻醉下的手术相比，患者通常更喜欢术中唤醒开颅术。
在巴西的患者群体中，脑肿瘤术中唤醒开颅术耐受性良好，满意度较高。不应以损害患者福祉为借口而避免使用该技术。
