Riquin Elise, Dinomais Mickael, Malka Jean, Lehousse Thierry, Duverger Philippe, Menei Philippe, Delion Matthieu
Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France.
Physical and Rehabilitation Medicine, University Hospital of Angers, Angers, France.
World Neurosurg. 2017 Jun;102:400-405. doi: 10.1016/j.wneu.2017.03.017. Epub 2017 Mar 12.
Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population.
The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients.
Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated.
None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress.
The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.
清醒状态下手术中的术中直接刺激被认为是识别明确皮质部位的金标准。仅有少数研究提及该事件对儿童群体的心理影响。
本临床研究的目的是呈现儿童清醒状态下手术的心理层面。我们质疑精神科禁忌证和年龄限制,以及对儿童的影响,尤其关注这些患者的心理状态和经历。
2008年至2015年期间,对7名年龄在8至16岁的脑损伤患儿进行了清醒状态下的手术。收集的数据包括对手术的感知和记忆、诊断情况以及术后的现实生活经历。对创伤后应激障碍或急性应激症状进行了调查。
所有儿童最初均无精神问题。术前未做出精神科诊断。儿童精神科医生未对任何一名儿童进行该手术提出禁忌。患者几乎没有预期性焦虑。没有儿童出现创伤后应激障碍或急性应激症状。
结果令人鼓舞,使我们能够考虑在不特别担心心理层面的情况下,对儿童进行清醒状态下的脑部手术。