Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Psychosomatic Medicine Research Center, Section of Neuropsychiatry, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.
J Neurosurg Sci. 2023 Aug;67(4):454-461. doi: 10.23736/S0390-5616.21.05323-6. Epub 2021 May 3.
Awake craniotomy (AC) is considered to achieve maximal safe resection of language eloquent gliomas. Impact of AC on the psychological status of patients (mainly anxiety, and post-traumatic stress disorder [PTSD]) is a potential concern. Despite the studies reporting the early postoperative patient's perception after AC, this study has been performed to quantitatively evaluate the long-term influence of AC on the level of anxiety/depression after surgery.
Patients who underwent AC for suspected language eloquent high-grade glioma were enrolled in this study. The anxiety, depression and PTSD of the patients were evaluated via hospital anxiety and depression scale (HADS) one week before and 1 and 6 months after the operation. PTSD symptoms were assessed according to the DSM-V checklist and confirmed by a structured clinical interview for DSM-V.
Twenty-eight patients (22 men, six women) with the mean age of 39.2 years were enrolled. The mean preoperative depressive and anxiety score was 4.9±5.9 and 7.7±5.8 respectively. One month after surgery they were 6±4.9 and 7.4±6.2 and at 6 months' follow-up 5.5±5.1 and 5.4±4.2 respectively. There was no statistically significant trend for alterations of the anxiety/depression levels before and after surgery. Female patients, those suspected to have glioblastoma and patients presenting with speech disturbance had remarkably higher preoperative anxiety levels. Three patients had PTSD symptoms 3 months after AC while at 6 months there was no indication of PTSD. The decremental trend of PTSD score within 6 months was statistically significant.
Judicious application of AC is not associated with an escalation of the anxiety/depression level among the patients. Even patients with high preoperative anxiety levels could be managed with AC without severe psychological deterioration.
唤醒开颅术（AC）被认为可以最大限度地安全切除语言功能区胶质瘤。AC 对患者心理状态（主要是焦虑和创伤后应激障碍 [PTSD]）的影响是一个潜在的关注点。尽管有研究报告了 AC 后早期患者的感知，但本研究旨在定量评估 AC 对术后焦虑/抑郁水平的长期影响。
本研究纳入了因疑似语言功能区高级别胶质瘤而行 AC 的患者。通过医院焦虑抑郁量表（HADS）在术前一周和术后 1 个月和 6 个月评估患者的焦虑、抑郁和 PTSD。根据 DSM-V 清单评估 PTSD 症状，并通过 DSM-V 结构化临床访谈进行确认。
共纳入 28 例患者（22 例男性，6 例女性），平均年龄为 39.2 岁。术前抑郁和焦虑评分分别为 4.9±5.9 和 7.7±5.8。术后 1 个月时分别为 6±4.9 和 7.4±6.2，术后 6 个月时分别为 5.5±5.1 和 5.4±4.2。手术前后焦虑/抑郁水平的变化无统计学意义。女性患者、疑似胶质母细胞瘤患者和出现言语障碍的患者术前焦虑水平明显升高。3 例患者在 AC 后 3 个月出现 PTSD 症状，6 个月时无 PTSD 迹象。6 个月内 PTSD 评分的递减趋势具有统计学意义。
明智地应用 AC 不会导致患者的焦虑/抑郁水平升高。即使是术前焦虑水平较高的患者，也可以通过 AC 进行管理，而不会出现严重的心理恶化。
