Clinical Scorecard: Awake Craniotomy Does Not Result in Higher Incidence of Psychological Issues

At a Glance

Key Highlights

• Awake craniotomy allows more extensive tumour resection with fewer neurological deficits compared to general anaesthesia.
• Psychological complaints including PTSD symptoms are rare and do not increase postoperatively after awake craniotomy.
• Different awake craniotomy anaesthesia techniques (asleep-awake-asleep, awake-awake-awake) have distinct risk profiles and patient experiences.

Guideline-Based Recommendations

Diagnosis

• Identify tumour location in eloquent brain areas to determine suitability for awake craniotomy.
• Assess preoperative psychological status to establish baseline anxiety, depression, and PTSD symptoms.

Management

• Use awake craniotomy with intraoperative neuropsychological testing to maximize tumour resection while preserving function.
• Select anaesthesia technique (asleep-awake-asleep, awake-awake-awake) based on patient safety and ability to tolerate procedure.
• Provide perioperative support to manage anxiety and pain during surgery.

Monitoring & Follow-up

• Monitor neurological function intraoperatively through neuropsychological testing.
• Assess postoperative psychological complaints including anxiety, depression, and PTSD symptoms.
• Evaluate patient attribution of psychological symptoms to tumour diagnosis, surgery, or postoperative diagnosis.

Risks

• Anaesthesia-related risks include nausea, hypoventilation, respiratory obstruction, confusion, and agitation.
• Potential residual sedation effects may impair intraoperative cooperation and alertness.
• Psychological impact of tumour diagnosis and surgery may cause anxiety but does not commonly lead to PTSD.

Patient & Prescribing Data

Adults undergoing first-time awake craniotomy for brain tumours in eloquent areas

Awake craniotomy is well tolerated with low incidence of postoperative psychological issues; careful patient selection and perioperative management optimize outcomes.

Clinical Best Practices

• Perform awake craniotomy in patients with tumours in eloquent brain regions to maximize functional preservation.
• Use intraoperative neuropsychological testing to guide tumour resection extent.
• Consider awake-awake-awake anaesthesia technique to minimize sedation-related risks when feasible.
• Screen and monitor psychological symptoms pre- and postoperatively to address patient needs.
• Educate patients and families about the nature of awake craniotomy and potential psychological impacts.

References

• Edmondson (2014) - Enduring Somatic Threat Model
• Milian et al. (2014) - Review on PTSD after Awake Craniotomy
• UMCU Awake Craniotomy Study (2014-2016)