Patient perceptions of "awake" brain tumour surgery.
BACKGROUND
Awake brain tumour surgery allows intraoperative patient assessment and is done to optimise safe tumour removal. It is an established technique but little is known about patient perceptions of the procedure.


METHODS
Fifteen adult patients filled out a dedicated questionnaire to assess 10 aspects of patient perceptions of the procedure.


RESULTS
All patients, who were awake for a median of 45 minutes (range 10-105), stated they were adequately prepared for the operation. Most recollected various aspects of the procedure, although 3 patients (20%) had little memory of actually being awake during the surgery despite being cooperative. A minority reported more than minor discomfort (20%), fear (15%) or anxiety (29%), and most felt they coped with the cortical stimulations and functional testing well. Sources of discomfort and pain were the cranial pin holding device, operative position, inadequate infiltration of the cranial wound with local anesthetic, a full bladder causing a desire to micturate and a hard and uncomfortable operating table.


CONCLUSIONS
These results, are very similar to a previous American report using a different anesthetic technique, in that most patients tolerate awake craniotomy remarkably well if the procedure is explained to them and some simple precautions are taken. Additionally between 8%-37% of patients (95% Confidence Interval, summing data from the two studies, n = 35) will have no recollection of being awake. Ways of minimising discomfort and problems of anxiety in this patient cohort are discussed.
Whittle
I R
IR
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK. irw@skull.dcn.edu.ac.uk
Midgley
S
S
Georges
H
H
Pringle
A-M
AM
Taylor
R
R
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000523:psychology; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods / Q000523:psychology; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000379:methods / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014851:Wakefulness / Q000502:physiology*