Bakhshi Saqib Kamran, Pidani Anum Sadruddin, Khalil Mujtaba, Shamim Muhammad Shahzad
Neurosurgery, Aga Khan University Hospital, Karachi, PAK.
Community Health Sciences, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2021 Nov 24;13(11):e19877. doi: 10.7759/cureus.19877. eCollection 2021 Nov.
Introduction Brain tumor resection under awake settings may cause significant psychological stress, which may lead to perioperative anxiety and depression. We conducted a prospective study to compare postoperative depression in patients undergoing awake craniotomy (AC) for tumor resection and compare it with patients undergoing tumor resection under general anesthesia (GA). Methods We conducted a prospective study at a tertiary care hospital. Non-probability consecutive sampling was performed, and patients with a preoperative diagnosis of depression or with any other medical comorbidities that could precipitate depression were excluded. Two separate questionnaires, the Patient Health Questionnaire-9 (PHQ-9) Scale and the Karnofsky Performance Score (KPS), were used to screen depression and assess functional status, respectively. Results Ninety-six patients met the inclusion criteria and were included in the study. Out of these, 37 (38.1%) had undergone awake craniotomy and 59 (60.8%) had undergone conventional craniotomy (CC) (under general anesthesia) for brain tumor resection. To standardize our method, we ensured that the demographic variables, including mean age, gender, educational status, marital status, and socioeconomic conditions, were comparable between both groups. Postoperative functional status fared better in patients who underwent awake craniotomy (p = 0.03). The total number of patients suffering from postoperative clinical depression, according to the PHQ-9 Scale, was 41 (42.7%), of which 12 (12.5%) were in the awake craniotomy group and 29 (30.2%) were in the conventional craniotomy group. The median PHQ-9 Scale score in the awake craniotomy group was 6 (range: 3-10), which was less than the median score in the conventional craniotomy group, which was 9 (range: 4-12). This difference, however, was not statistically significant (p = 0.06). Conclusion Resection of brain tumors under awake conditions is not likely associated with any additional incidence of postoperative depression when compared with resection of tumors under general anesthesia.
引言 在清醒状态下进行脑肿瘤切除术可能会导致显著的心理压力，这可能会引发围手术期焦虑和抑郁。我们进行了一项前瞻性研究，以比较接受清醒开颅手术（AC）切除肿瘤的患者术后抑郁情况，并将其与接受全身麻醉（GA）下肿瘤切除术的患者进行比较。
方法 我们在一家三级护理医院进行了一项前瞻性研究。采用非概率连续抽样，排除术前诊断为抑郁症或有任何其他可能引发抑郁症的内科合并症的患者。分别使用两份问卷，即患者健康问卷-9（PHQ-9）量表和卡诺夫斯基功能状态评分（KPS），来筛查抑郁情况和评估功能状态。
结果 96名患者符合纳入标准并被纳入研究。其中，37名（38.1%）接受了清醒开颅手术，59名（60.8%）接受了传统开颅手术（CC，在全身麻醉下）切除脑肿瘤。为使我们的方法标准化，我们确保两组间的人口统计学变量，包括平均年龄、性别、教育程度、婚姻状况和社会经济状况具有可比性。接受清醒开颅手术的患者术后功能状态更好（p = 0.03）。根据PHQ-9量表，术后发生临床抑郁的患者总数为41名（42.7%），其中清醒开颅手术组有12名（12.5%），传统开颅手术组有29名（30.2%）。清醒开颅手术组的PHQ-9量表中位评分为6（范围：3 - 10），低于传统开颅手术组的中位评分9（范围：4 - 12）。然而，这种差异无统计学意义（p = 0.06）。
结论 与全身麻醉下切除肿瘤相比，清醒状态下切除脑肿瘤不太可能与术后抑郁的额外发生率相关。
