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Patients’ perspective on awake craniotomy for brain tumors—single center experience in Brazil

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Awake craniotomy with brain mapping is the gold standard for eloquent tissue localization. Patients’ tolerability and satisfaction have been shown to be high; however, it is a matter of debate whether these findings could be generalized, since patients across the globe have their own cultural backgrounds and may perceive and accept this procedure differently.

Methods

We conducted a prospective qualitative study about the perception and tolerability of awake craniotomy in a population of consecutive brain tumor patients in Brazil between January 2013 and April 2015. Seventeen patients were interviewed using a semi-structured model with open-ended questions.

Results

Patients’ thoughts were grouped into five categories: (1) overall perception: no patient considered awake craniotomy a bad experience, and most understood the rationale behind it. They were positively surprised with the surgery; (2) memory: varied from nothing to the entire surgery; (3) negative sensations: in general, it was painless and comfortable. Remarks concerning discomfort on the operating table were made; (4) postoperative recovery: perception of the postoperative period was positive; (5) previous surgical experiences versus awake craniotomy: patients often preferred awake surgery over other surgery under general anesthesia, including craniotomies.

Conclusions

Awake craniotomy for brain tumors was well tolerated and yielded high levels of satisfaction in a population of patients in Brazil. This technique should not be avoided under the pretext of compromising patients’ well-being.

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References

  1. Beez T, Boge K, Wager M, Whittle I, Fontaine D, Spena G, Braun S, Szelényi A, Bello L, Duffau H, Sabel M, European Low Grade Glioma Network (2013) Tolerance of awake surgery for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir 155:1301–1308

    Article  PubMed  Google Scholar 

  2. Chang SM, Parney IF, Huang W, Anderson FA Jr, Asher AL, Bernstein M, Lillehei KO, Brem H, Berger MS, Laws ER, Glioma Outcomes Project Investigators (2005) Patterns of care for adults with newly diagnosed malignant glioma. JAMA 293(5):557–564

    Article  CAS  PubMed  Google Scholar 

  3. Danks RA, Aglio LS, Gugino LD, Black PM (2000) Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. J Neurooncol 49:131–139

    Article  CAS  PubMed  Google Scholar 

  4. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS (2012) Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 30(20):2559–2565

    Article  PubMed  Google Scholar 

  5. Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS (2015) Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 123(2):325–339

    Article  PubMed  Google Scholar 

  6. Huston P, Rowan M (1998) Qualitative studies. Their role in medical research. Can Fam Physician 44:2453–2458

    CAS  PubMed  PubMed Central  Google Scholar 

  7. July J, Manninen P, Lai J, Yao Z, Bernstein M (2009) The history of awake craniotomy for brain tumor and its spread into Asia. Surg Neurol 71(5):621–624, discussion 624–5

    Article  PubMed  Google Scholar 

  8. Khu KJ, Bernstein M (2013) Awake craniotomy. J Neurosurg 119(6):1645

    Article  PubMed  Google Scholar 

  9. Khu KJ, Doglietto F, Radovanovic I, Taleb F, Mendelsohn D, Zadeh G, Bernstein M (2010) Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. J Neurosurg 112(5):1056–1060

    Article  PubMed  Google Scholar 

  10. Lopez GI, Figueroa M, Connor SE, Maliski SL (2008) Translation barriers in conducting qualitative research with Spanish speakers. Qual Health Res 18(12):1729–1737

    Article  PubMed  Google Scholar 

  11. Manchella S, Khurana VG, Duke D, Brussel T, French J, Zuccherelli L (2011) The experience of patients undergoing awake craniotomy for intracranial masses: expectations, recall, satisfaction and functional outcome. Br J Neurosurg 25:391–400

    Article  PubMed  Google Scholar 

  12. Manninen PH, Tan TK (2002) Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia. J Clin Anesth 14(4):279–283

    Article  PubMed  Google Scholar 

  13. McGirt MJ, Mukherjee D, Chaichana KL, Than KD, Weingart JD, Quinoñes-Hinojosa A (2009) Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery 65(3):463–469, discussion 469–70

    Article  PubMed  Google Scholar 

  14. Palese A, Skrap M, Fachin M, Visioli S, Zannini L (2008) The experience of patients undergoing awake craniotomy: in the patients’ own words. A qualitative study. Cancer Nurs 31(2):166–172

    Article  PubMed  Google Scholar 

  15. Purzner T, Purzner J, Massicotte EM, Bernstein M (2011) Outpatient brain tumor surgery and spinal decompression: a prospective study of 1003 patients. Neurosurgery 69(1):119–126, discussion 126–7

    Article  PubMed  Google Scholar 

  16. Sacko O, Lauwers-Cances V, Brauge D, Sesay M, Brenner A, Roux FE (2011) Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 68:1192–1198, discussion 1198–1199

    Article  PubMed  Google Scholar 

  17. Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358(1):18–2

    Article  CAS  PubMed  Google Scholar 

  18. Sartorius C, Berger M (1998) Rapid termination of intraoperative stimulation-evoked seizures with application of cold Ringer’s lactate to the cortex: technical note. J Neurosurg 88:349–351

    Article  CAS  PubMed  Google Scholar 

  19. Szelényi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M, Neuloh G, Signorelli F, Sala F (2010) Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 28(2):E7

    Article  PubMed  Google Scholar 

  20. van Nes F, Abma T, Jonsson H, Deeg D (2010) Language differences in qualitative research: is meaning lost in translation? Eur J Ageing 7(4):313–316

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wahab SS, Grundy PL, Weidmann C (2011) Patient experience and satisfaction with awake craniotomy for brain tumours. Br J Neurosurg 25(5):606–613

    Article  CAS  PubMed  Google Scholar 

  22. Whittle IR, Midgley S, Georges H, Pringle A-M, Taylor R (2005) Patient perceptions of “awake” brain tumour surgery. Acta Neurochir (Wien) 147(3):275–277, discussion 277

    Article  CAS  Google Scholar 

  23. Wrede KH, Stieglitz LH, Fiferna A, Karst M, Gerganov VM, Samii M, von Gösseln HH, Lüdemann WO (2011) Patient acceptance of awake craniotomy. Clin Neurol Neurosurg 113:880–884

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departamento de Neurocirurgia, Hospital Universitario Antonio Pedro, Universidade Federal Fluminense, Rua Marques de Parana, 303, 3o andar, 24033-900, Niteroi, Rio de Janeiro, Brazil

    Rafael Teixeira Magalhaes Leal, Clovis Orlando da Fonseca & Jose Alberto Landeiro

Authors
  1. Rafael Teixeira Magalhaes Leal
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  2. Clovis Orlando da Fonseca
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  3. Jose Alberto Landeiro
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Corresponding author

Correspondence to Rafael Teixeira Magalhaes Leal.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

None

Ethical approval

The research protocol was approved by the Ethics Committee of the Universidade Federal Fluminense. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Postoperative interview

  1. 1.

    How would you describe your experience with this type of surgery?

  2. 2.

    Do you remember anything during surgery? If so, what?

  3. 3.

    What most bothered you during surgery?

  4. 4.

    Did you feel pain at some point? If yes, when and what was its intensity?

  5. 5.

    For how long did you have the feeling you were awake?

  6. 6.

    Do you remember the doctors talking to each other during surgery? If so, did it bother you? If not, would it bother you?

  7. 7.

    How did you feel right after surgery, still in the operating room?

  8. 8.

    Do you think you were sufficiently informed about the surgery before it occurred?

  9. 9.

    In general, were you satisfied with the outcome of the surgery?

  10. 10.

    Do you think you contributed more to your surgery because you were awake?

  11. 11.

    If you were a surgeon, would you do something different to improve patients’ comfort? If so, what?

  12. 12.

    If you could go back in time, would you have opted for the traditional surgery, now that you know exactly how the surgery with the patient awake occurs?

  13. 13.

    At what point, after surgery, did you feel well enough to be discharged to go home?

  14. 14.

    Have you ever been subjected to a surgery before? If so, compare that experience with the awake neurosurgery.

  15. 15.

    Would you like to add something?

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Leal, R.T.M., da Fonseca, C.O. & Landeiro, J.A. Patients’ perspective on awake craniotomy for brain tumors—single center experience in Brazil. Acta Neurochir 159, 725–731 (2017). https://doi.org/10.1007/s00701-017-3125-0

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  • DOI: https://doi.org/10.1007/s00701-017-3125-0

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