TY - JOUR
T1 - Tolerance of awake surgery for glioma
T2 - A prospective European Low Grade Glioma Network multicenter study
AU - Beez, Thomas
AU - Boge, Kira
AU - Wager, Michel
AU - Whittle, Ian
AU - Fontaine, Denys
AU - Spena, Giannantonio
AU - Braun, Sebastian
AU - Szelényi, Andrea
AU - Bello, Lorenzo
AU - Duffau, Hugues
AU - Sabel, Michael
PY - 2013/7
Y1 - 2013/7
N2 - Background: Gross total removal of glioma is limited by proximity to eloquent brain. Awake surgery allows for intraoperative monitoring to safely identify eloquent regions. However, data on adverse psychological effects induced in these patients is limited. Objective: This study explored patients' perception of awake surgery for glioma, with special focus on intraoperative pain and anxiety. Methods: This study was conducted at five neurosurgical centers within the European Low Grade Glioma Network. Patients underwent awake surgery for glioma according to the protocol of the individual center. Pain and discomfort were measured during the awake phase. Postoperatively, patients answered a questionnaire on aspects of their operation. Results: One hundred five patients were enrolled. Pain levels on a 10-cm visual analogue scale were 1.3 cm at the beginning, 1.9 cm the middle, and 2.1 cm at the end of awake phase. Levels of anxiety were 2.2 cm, 2.5 cm and 2.6 cm, respectively. Women and patients younger than 60 years exhibited highest mean anxiety levels. The patient questionnaire revealed that the majority of patients feel comfortable with the procedure. Discomfort resulted from head fixation or positioning on the operating table. Conclusions: We demonstrate that awake surgery is well tolerated, as neither intraoperative nor postoperative assessment revealed major disadvantages. Concerning practical lessons learned from this study, we emphasize the importance of minimizing pain and preparing patients thoroughly to reduce anxiety and maximize cooperation. Awake surgery is an excellent treatment modality for brain tumors with very positive perception by patients.
AB - Background: Gross total removal of glioma is limited by proximity to eloquent brain. Awake surgery allows for intraoperative monitoring to safely identify eloquent regions. However, data on adverse psychological effects induced in these patients is limited. Objective: This study explored patients' perception of awake surgery for glioma, with special focus on intraoperative pain and anxiety. Methods: This study was conducted at five neurosurgical centers within the European Low Grade Glioma Network. Patients underwent awake surgery for glioma according to the protocol of the individual center. Pain and discomfort were measured during the awake phase. Postoperatively, patients answered a questionnaire on aspects of their operation. Results: One hundred five patients were enrolled. Pain levels on a 10-cm visual analogue scale were 1.3 cm at the beginning, 1.9 cm the middle, and 2.1 cm at the end of awake phase. Levels of anxiety were 2.2 cm, 2.5 cm and 2.6 cm, respectively. Women and patients younger than 60 years exhibited highest mean anxiety levels. The patient questionnaire revealed that the majority of patients feel comfortable with the procedure. Discomfort resulted from head fixation or positioning on the operating table. Conclusions: We demonstrate that awake surgery is well tolerated, as neither intraoperative nor postoperative assessment revealed major disadvantages. Concerning practical lessons learned from this study, we emphasize the importance of minimizing pain and preparing patients thoroughly to reduce anxiety and maximize cooperation. Awake surgery is an excellent treatment modality for brain tumors with very positive perception by patients.
KW - Awake surgery
KW - Brain mapping
KW - Glioma
KW - Patients' perception
KW - Visual analogue scale
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U2 - 10.1007/s00701-013-1759-0
DO - 10.1007/s00701-013-1759-0
M3 - Article
C2 - 23689968
AN - SCOPUS:84879210110
VL - 155
SP - 1301
EP - 1308
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 7
ER -