IntroductionBrain tumor resection under awake settings may cause significant psychological stress, which may lead to perioperative anxiety and depression. We conducted a prospective study to compare postoperative depression in patients undergoing awake craniotomy (AC) for tumor resection and compare it with patients undergoing tumor resection under general anesthesia (GA). MethodsWe conducted a prospective study at a tertiary care hospital. Non-probability consecutive sampling was performed, and patients with a preoperative diagnosis of depression or with any other medical comorbidities that could precipitate depression were excluded. Two separate questionnaires, the Patient Health Questionnaire-9 (PHQ-9) Scale and the Karnofsky Performance Score (KPS), were used to screen depression and assess functional status, respectively. ResultsNinety-six patients met the inclusion criteria and were included in the study. Out of these, 37 (38.1%) had undergone awake craniotomy and 59 (60.8%) had undergone conventional craniotomy (CC) (under general anesthesia) for brain tumor resection. To standardize our method, we ensured that the demographic variables, including mean age, gender, educational status, marital status, and socioeconomic conditions, were comparable between both groups. Postoperative functional status fared better in patients who underwent awake craniotomy (p = 0.03). The total number of patients suffering from postoperative clinical depression, according to the PHQ-9 Scale, was 41 (42.7%), of which 12 (12.5%) were in the awake craniotomy group and 29 (30.2%) were in the conventional craniotomy group. The median PHQ-9 Scale score in the awake craniotomy group was 6 (range: 3-10), which was less than the median score in the conventional craniotomy group, which was 9 (range: 4-12). This difference, however, was not statistically significant (p = 0.06). ConclusionResection of brain tumors under awake conditions is not likely associated with any additional incidence of postoperative depression when compared with resection of tumors under general anesthesia.

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Background: Several studies have highlighted the use of human amniotic membrane (HAM) in neurosurgical procedures as an effective dural substitute. HAM has inherent antifibrotic and anti-inflammatory properties and exhibits immunomodulatory effect that makes it an ideal dural substitute. Other advantages including easy availability, low cost of procurement, and storage also render it a promising dural substitute especially in low- and middle-income countries. Methods: A systematic literature search was performed using PubMed, Scopus, and Google Scholar databases, using the search terms “human amniotic membrane,” “dural repair,” and “neurosurgery.” To be eligible for inclusion in our review, papers had to report primary data, be published in English language and report dural repair on humans with human amniotic membrane. Eligibility assessment was conducted by two independent reviewers with qualitative analysis on the basis of surgical utility, postoperative complications, and histological analysis. Results: Eight articles met the predefined inclusion criteria, including three randomized control trials and five cohort studies. We evaluated the use of HAM grafts in dural repair for elective cranial surgery (four studies), trauma surgery (three studies), and elective spine surgery (one study). Cases with postoperative cerebrospinal fluid (CSF) leak were reported by two studies. Other postoperative complications including meningitis, hydrocephalus, pseudomeningocele, CSF collection in subdural space, and subacute subdural hematoma were reported by one study each. Postsurgical histological analysis was reported by three studies highlighting the antiadhesive and integrative properties of HAM. Conclusion: The current review of evidence suggests that in terms of postsurgical outcomes, HAM is comparable with commercially available dural substitutes.