Role of Clinical Neuropsychologists in Awake-Craniotomy

Abstract

Background: Awake craniotomy encompasses surgical resection of focal zone of neurological impairment, using intraoperative functional zone mapping. The strength of the procedure is maximum retention of functionally significant zones to ensure better function and quality of life outcomes in patients. A clinical neuropsychologist plays a vital role in profiling the patient's cognitive and psychosocial functioning as well as increasing the efficacy of functional zone mapping procedures. Objective: Aim of this article is to summarize the literature on the role of clinical neuropsychologists in awake craniotomy and underscoring the need for establishing standardized operating procedures for neuropsychologists in awake craniotomy highlighting experiential anecdotes from a tertiary care facility. Materials and Methods: A review of articles that elucidate the role of clinical neuropsychologists was done and summarized to highlight the role of clinical neuropsychologists. An attempt was made to explain the implementation of this role in regular clinical practice at a tertiary care facility. Results: The role of a clinical neuropsychologist is highly crucial at pre-/during and postawake craniotomy, and has a significant bearing on the overall psychological outcome of the individual. The need for a standardized protocol to unify practice and increase the efficacy of the awake-craniotomy procedure is put forth. Recommendations for future directions in research to increase the scope of neuropsychologists in awake craniotomy have also been made.

Awake craniotomies in South America: Advancements, challenges, and future prospects

“…Active and sustained initiatives are required to address the fear and anxiety associated with neurosurgical interventions, specifically AC. 46 In this context, the involvement of clinical neuropsychologists is paramount throughout the entire AC process, encompassing the pre-operative, intra-operative, and post-operative phases, particularly in relation to the psychological well-being of the patient. Establishing a standardised protocol is imperative for clinical psychologists, outlining the assessment toolkit, interview schedule, pre-surgery intervention techniques, and pre-post neuropsychological assessments.…”

The efficacy and safety of using a combination of rocuronium and sugammadex for awake craniotomy anesthesia: A randomized clinical trial

“…All patients received psychological counseling. [10] The patients arrived in the operating room without any premedication and lay supine on the operating table. Nurses attached standard monitors to record vital signs, including noninvasive BP monitoring, ECG, and pulse oximetry (SpO2).…”

Asociación Mexicana de Neuropsicología. 25 años de práctica clínica e investigación

“…De tal manera que, a diferencia de la evaluación diagnóstica, esta presenta un objetivo muy específico. Aunque puede fortalecer un diagnóstico previo, la evaluación preparativa ayuda a establecer una línea de comparación clara que facilite la detección de signos frente a la estimulación cortical, la cual se da en condiciones restrictivas como la posición del paciente y el tiempo de respuesta mínimo requerido (Díaz-Agustín et al, 2022;Hande et al, 2021). Aunque, precisamente, no se trate de una evaluación como tal, sí es importante la estimulación durante el acto quirúrgico, la cual realiza el neuropsicólogo con las herramientas disponibles, ya que, en este caso, no hay pruebas estandarizadas para dicho propósito, sino tareas qué efectuar.…”

“…De forma particular, en el transquirúrgico, a partir de la neuropsicología, se han de estimular o monitorear distintos procesos (tabla 1). Duffau, 2011aDuffau, , 2011bHande et al, 2021;Núñez-Velasco et al, 2020;Tomasino et al, 2021;van Kessel et al, 2020. Con base en lo anterior, las decisiones neuroquirúrgicas han sido influenciadas por la dominancia cerebral izquierda. Sin embargo, el hemisferio subdominante se considera cada vez más, debido a los déficits cognitivos y conductuales que se observan después de resecciones tumorales derechas (Lemée et al, 2018).…”

“…Por otro lado, de manera independiente del acto quirúrgico per se, es sumamente importante el monitoreo cognitivo a fin de iniciar, lo antes posible, la rehabilitación neuropsicológica e impactar en la funcionalidad y calidad de vida del paciente (Duffau, 2011b;Hande et al, 2021).…”