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

Abstract

BACKGROUND: Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE: To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS: Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awakeawake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION: In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.

Awake Craniotomy During Pregnancy: A Systematic Review of The Published Literature

“…Various strategies should be employed to support the physical and mental well-being of the patient to deliver a healthy and viable child. Indeed, AC has been shown to result in a lower psychological sequel for the patient, even in low-resource settings [21,55]. Furthermore, ethical considerations should be addressed regarding the well-being of the patient and maintenance of the pregnancy or preterm termination [61,62].…”

“…Multiple factors, including type, size, and location of the brain pathology, neurological symptoms, fetus age, and mother wellbeing should be considered before neurosurgical interventions during pregnancy. AC is associated with shorter hospitalization, fewer neurological de cits, improved psychological outcomes, and better prognosis and can be utilized in low-resource settings [21,55,56]. AC has been used for various surgical indications, including tumor [20,57], epilepsy [58, 59], and aneurysms [31] to enhance patients' outcomes [26,60].…”

“…Lesions in eloquent areas require awake craniotomy (AC) for real-time monitoring of neurological functions, including motor, language, and vision [16][17][18][19][20]. Recent studies show AC is a safe procedure with fewer post-operative complications such as stress and anxiety for patients [21].…”

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

“…Anxiety, stress, and cognitive impairment can influence the anesthetic management and patient outcome in awake craniotomy [12]. Well motivated and mature patients who can tolerate lying still for several hours and cooperate during testing are the best candidates for awake craniotomy.…”

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

“…This systematic review evaluates the available literature regarding psychologic impacts awake craniotomies have on patients during the preoperative, perioperative, and postoperative periods. This article 1 does well at summarizing the impact an awake craniotomy has on patient levels of anxiety, stress, and depression. The authors demonstrate that the awake craniotomy procedure has a minimal impact on these psychologic factors and patient well-being in the perioperative and postoperative periods.…”