Huguet Ludivine, Lohkamp Laura-Nanna, Beuriat Pierre-Aurelien, Desmurget Michel, Bapteste Lionel, Szathmari Alexandru, Mottolese Carmine, Di Rocco Federico
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France.
Department of Medical Psychology, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France.
Childs Nerv Syst. 2020 Feb;36(2):273-279. doi: 10.1007/s00381-019-04308-8. Epub 2019 Jul 27.
Awake brain surgery (ABS) in children remains a subject of controversial debate for the potential psychological limitations that are related to this type of procedure. However, the tolerance and benefits of ABS in adults advocate for increased application of ABS in children. In this study, we report the psychological assessment, evaluation algorithm, and outcome of pediatric patients, who underwent ABS for surgical treatment of lesions in eloquent areas. Psychological selection criteria and the specifications of psychological support are described. A retrospective review and analysis of psychological assessment and psychological outcome of pediatric patients, who underwent ABS between 2005 and 2018 at the Department of pediatric neurosurgery, University of Lyon, France, was performed. Long-term psychological outcomes are reported. ABS was proposed to 18 children aged between 9 and 17 years and their families. After psychological evaluation of the individual patient and their familial surrounding, five boys and 12 girls (n = 17) were accounted eligible for ABS. They underwent asleep-awake-asleep brain surgery with intraoperative testing. In 16 cases, ABS could be performed as planned. Psychological alterations were postoperatively observed in 3 patients, symptoms of a post-traumatic stress disorder in 1 patient. The precise preoperative evaluation of the risk-benefit ratio in children plays a crucial role in anticipating a good psychological outcome. Professional psychological preparation and support of the child and his or her family are the key elements for successful completion of ABS.
由于与这类手术相关的潜在心理限制，儿童清醒开颅手术（ABS）仍然是一个有争议的话题。然而，成人对ABS的耐受性和益处支持在儿童中增加ABS的应用。在本研究中，我们报告了因手术治疗功能区病变而接受ABS的儿科患者的心理评估、评估算法和结果。描述了心理选择标准和心理支持的具体内容。对2005年至2018年期间在法国里昂大学儿科神经外科接受ABS的儿科患者的心理评估和心理结果进行了回顾性分析。报告了长期心理结果。向18名年龄在9至17岁的儿童及其家属提出了ABS手术。在对个体患者及其家庭环境进行心理评估后，5名男孩和12名女孩（n = 17）被认为符合ABS手术条件。他们接受了术中测试的清醒-睡眠-清醒开颅手术。16例患者能够按计划进行ABS手术。术后观察到3例患者有心理改变，1例患者有创伤后应激障碍症状。对儿童术前风险效益比进行精确评估对于预期良好的心理结果起着关键作用。对儿童及其家庭进行专业的心理准备和支持是成功完成ABS手术的关键因素。
