Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Neurosurgery, 2023 · DOI: https://doi.org/10.1227/neu.0000000000002224 · Published: February 1, 2023

Simple Explanation

Awake craniotomy (AC) is a neurosurgical technique that allows real-time monitoring of brain functions during surgery. Patients undergoing AC may experience stressors that affect their mental health. This systematic review aimed to understand the levels of stress, anxiety, and depression in patients undergoing AC by analyzing published studies. The review found that in experienced hands, AC does not generally increase stress, anxiety, or depression, but the psychiatric impact should still be considered.

Study Duration

January 1, 2000, to April 20, 2022

Participants

1450 patients from 13 countries

Evidence Level

Systematic Review

Key Findings

1
The review included 24 articles consisting of 1450 patients from 13 countries, with anxiety being the most common psychological outcome evaluated.
2
Most studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in patients, with one study finding younger age associated with panic attacks.
3
Glioma was the most common AC treatment, accounting for 42.4% of patients.

Research Summary

This systematic review examined the psychiatric impact of awake craniotomy (AC) by analyzing 24 studies involving 1450 patients. The review aimed to determine whether AC leads to increased stress, anxiety, and depression. The findings suggest that AC, when performed by experienced teams, generally does not elevate stress, anxiety, or depression levels in patients. However, the psychiatric impact of AC should not be underestimated. The review highlights the importance of comprehensive psychiatric assessments during all phases of AC (preoperative, intraoperative, and postoperative) to improve patient outcomes and manage potential psychiatric challenges effectively.

Practical Implications

Patient Selection and Preparation

Careful preoperative assessment and psychological preparation are crucial to ensure patients are suitable candidates for AC and to minimize potential distress.

Multidisciplinary Approach

A multidisciplinary team, including neurosurgeons, anesthesiologists, psychiatrists/psychologists, and specialized nurses, is essential to provide comprehensive support and manage psychiatric outcomes effectively.

Anesthetic Protocol Consideration

Consideration of different anesthesia protocols, such as awake-awake-awake or asleep-awake-asleep, based on patient comfort and specific needs can help mitigate potential adverse events and improve overall experience.

Study Limitations

1
The review was limited to articles published in English.
2
Heterogeneity in the included articles, particularly regarding assessment tools and study design.
3
The number of patients in each study and the data collection period varied widely, impacting the strength of analyses.

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