title: "Imagine your neighbor mows the lawn": a pilot study of psychological sequelae due to awake craniotomy: clinical article.
abstract: OBJECTIVE
  Although it has been reported that awake neurosurgical procedures are well tolerated, the long-term occurrence of general psychological sequelae has not yet been investigated. This study assessed the frequency and effects of psychological symptoms after an awake craniotomy on health-related quality of life (HRQOL).
  
  
  METHODS
  Sixteen patients undergoing an awake surgery were surveyed with a self-developed questionnaire, the Posttraumatic Stress Disorder Inventory For Awake Surgery Patients, which adopts the core components of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) posttraumatic stress disorder (PTSD) criteria. The mean time between surgery and data collection was 97.3 ± 93.2 weeks. Health-related quality of life was assessed with the 36-Item Short Form Health Survey.
  
  
  RESULTS
  Forty-four percent of the patients stated that they had experienced either repetitive distressing recollections or dreams related to the awake surgery, 18.8% stated persistent avoidance of stimuli associated with the awake surgery, and symptoms of increased arousal occurred in 62.5%. Two patients presented with postoperative psychological sequelae resembling PTSD symptoms. Younger age at surgery and female sex were risk factors for symptoms of increased arousal. The experience of intense anxiety during awake surgery appears to favor the development of postsurgical PTSD symptoms, while recurrent distressing recollections particularly affect HRQOL negatively.
  
  
  CONCLUSIONS
  In many cases awake craniotomy is necessary to preserve language and motor function. However, in some cases awake craniotomy can lead to postoperative psychological sequelae resembling PTSD symptoms. Therefore, possible long-term effects of an awake surgery should be considered and discussed with the patient when planning this type of surgery.
authors.affiliation: Department of Neurosurgery, University Hospital Tuebingen, Germany. monika.milian@med.uni-tuebingen.de
authors.forename: Monika
authors.initials: M
authors.lastname: Milian
authors.forename: Ralf
authors.initials: R
authors.lastname: Luerding
authors.forename: Annette
authors.initials: A
authors.lastname: Ploppa
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Decker
authors.forename: Tsambika
authors.initials: T
authors.lastname: Psaras
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
authors.forename: Alireza
authors.initials: A
authors.lastname: Gharabaghi
authors.forename: Guenther C
authors.initials: GC
authors.lastname: Feigl
mesh_terms: D000328:Adult; D000367:Age Factors; D003243:Consciousness; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires