Advertisement

Evaluating Awake Craniotomies in Glioma Patients: Meeting the Challenge

  • Bart Lutters
  • Marike L. D. BroekmanEmail author
Chapter
  • 148 Downloads

Abstract

Awake craniotomies are increasingly applied during resective glioma surgery. Even though the technique has had a significant impact on patient care, several questions regarding its efficacy and risks remain to be elucidated. This poses a challenge to the neurosurgical community, as the use of large randomized trials may be infeasible. The Institute of Medicine has recently introduced the learning health system, a system that aims to facilitate continuous learning activities by tempering the traditional dividing line between clinical research and clinical care. Here, we aim to identify the various challenges associated with evaluating awake craniotomies in glioma patients and to propose the learning healthcare system and its associated ethics framework as a potential solution.

References

  1. 1.
    Greenblatt S. A history of neurosurgery: in its scientific and professional contexts. New York: Thieme; 1997. p. 23–5.Google Scholar
  2. 2.
    Olsen L, Aisner D, McGinnis JM. The learning healthcare system: workshop summary (IOM roundtable on evidence-based medicine). Washington DC: National Academies Press; 2007.Google Scholar
  3. 3.
    Broekman ML, Carrière ME, Bredenoord AL. Surgical innovation: the ethical agenda: a systematic review. Medicine (Baltimore). 2016;95(25):e3790.CrossRefGoogle Scholar
  4. 4.
    McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. The Lancet. 2009;374:1105–12.CrossRefGoogle Scholar
  5. 5.
    Brown T, Shah AH, Bregy A, Shah NH, Thambuswamy M, Barbarite, et al. Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol. 2013;25:240–7.CrossRefGoogle Scholar
  6. 6.
    Kirsch B, Bernstein M. Ethical challenges with awake craniotomy for tumor. Can J Neurol Sci. 2012;39:78–82.CrossRefGoogle Scholar
  7. 7.
    Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg. 2007;107:1–6.CrossRefGoogle Scholar
  8. 8.
    Bernstein M. Fully informed consent is impossible in surgical clinical trials. Can J Surg. 2005;48:271.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Appelbaum PS, Roth LH, Lidz CW, Benson P, Winslade W. False hopes and best data: consent to research and the therapeutic misconception. Hast Cent Rep. 1987;17:20–4.CrossRefGoogle Scholar
  10. 10.
    Kass NE, Faden RR, Goodman SN, Pronovost P, Tunis S, Beauchamp TL. The research-treatment distinction: a problematic approach for determining which activities should have ethical oversight. Hast Cent Rep. 2013;43:4–15.CrossRefGoogle Scholar
  11. 11.
    Faden RR, Kass NE, Goodman SN, Pronovost P, Tunis S, Beauchamp TL. An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics. Hast Cent Rep. 2013;43:16–27.CrossRefGoogle Scholar
  12. 12.
    Ford PJ. Vulnerable brains: research ethics and neurosurgical patients. J Law Med Ethics. 2009;37:73–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryErasmus University Medical CenterRotterdamThe Netherlands
  2. 2.Department of Pediatric NeurosurgeryBrain Center Rudolf Magnus, University Medical Center Utrecht—Princess Máxima CenterUtrechtThe Netherlands
  3. 3.Department of Neurosurgery, Computational Neurosciences Outcomes Center (CNOC)Brigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Department of NeurosurgeryHaaglanden Medical CenterThe HagueThe Netherlands
  5. 5.Department of NeurosurgeryLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations