Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
Acta Neurochir (Wien). 2023 Sep;165(9):2505-2512. doi: 10.1007/s00701-023-05615-5. Epub 2023 May 24.
Patients with brain tumours are increasingly treated by using the awake craniotomy technique. Some patients may experience anxiety when subjected to brain surgery while being fully conscious. However, there has been only limited research into the extent to which such surgeries actually result in anxiety or other psychological complaints. Previous research suggests that undergoing awake craniotomy surgery does not lead to psychological complaints, and that post-traumatic stress disorders (PTSD) are uncommon following this type of surgery. It must be noted, however, that many of these studies used small random samples.
In the current study, 62 adult patients completed questionnaires to identify the degree to which they experienced anxiety, depressive and post-traumatic stress complaints following awake craniotomy using an awake-awake-awake procedure. All patients were cognitively monitored and received coaching by a clinical neuropsychologist during the surgery.
In our sample, 21% of the patients reported pre-operative anxiety. Four weeks after surgery, 19% of the patients reported such complaints, and 24% of the patients reported anxiety complaints after 3 months. Depressive complaints were present in 17% (pre-operative), 15% (4 weeks post-operative) and 24% (3 months post-operative) of the patients. Although there were some intra-individual changes (improvement or deterioration) in the psychological complaints over time, on group-level postoperative levels of psychological complaints were not increased relative to the preoperative level of complaints. The severity of post-operative PTSD-related complaints were rarely suggestive of a PTSD. Moreover, these complaints were seldom attributed to the surgery itself, but appeared to be more related to the discovery of the tumour and the postoperative neuropathological diagnosis.
The results of the present study do not indicate that undergoing awake craniotomy is associated with increased psychological complaints. Nevertheless, psychological complaints may well exist as a result of other factors. Consequently, monitoring the patient's mental wellbeing and offering psychological support where necessary remain important.
越来越多的脑瘤患者采用清醒开颅手术进行治疗。当患者在完全清醒的状态下接受脑部手术时，可能会感到焦虑。然而，对于此类手术实际上会导致何种程度的焦虑或其他心理问题，研究仍非常有限。既往研究表明，清醒开颅手术不会导致心理问题，且这种类型的手术后创伤后应激障碍（PTSD）并不常见。但是，必须注意的是，这些研究中的许多研究使用的是小样本随机抽样。
在目前的研究中，62 名成年患者完成了问卷调查，以确定他们在使用清醒-清醒-清醒程序进行清醒开颅手术后经历焦虑、抑郁和创伤后应激的程度。所有患者在手术期间都接受认知监测，并由临床神经心理学家提供指导。
在我们的样本中，21%的患者报告术前焦虑。术后 4 周，19%的患者报告有此类症状，术后 3 个月，24%的患者报告焦虑症状。17%（术前）、15%（术后 4 周）和 24%（术后 3 个月）的患者出现抑郁症状。尽管随着时间的推移，心理症状出现了一些个体内变化（改善或恶化），但在组水平上，术后的心理症状并未高于术前。术后 PTSD 相关症状的严重程度很少提示 PTSD。此外，这些症状似乎与手术本身关系不大，而是更多地与肿瘤的发现和术后神经病理学诊断有关。
本研究结果表明，清醒开颅手术不会导致心理问题增加。然而，也可能存在其他因素导致的心理问题。因此，监测患者的心理健康并在必要时提供心理支持仍然很重要。
