Awake Craniotomy and Coaching
Author(s)
Carla Ruis1,2*,
Irene M. C. Huenges Wajer1,
Pierre A. J. T. Robe1,
Martine J. E. van Zandvoort1,2
Affiliation(s)
1 Department of Neurology & Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. 2 Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
1 Department of Neurology & Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. 2 Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
ABSTRACT
Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.
Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.
Cite this paper
Ruis, C. , Wajer, I. , Robe, P. and Zandvoort, M. (2014) Awake Craniotomy and Coaching. Open Journal of Medical Psychology, 3, 382-389. doi: 10.4236/ojmp.2014.35040.
Ruis, C. , Wajer, I. , Robe, P. and Zandvoort, M. (2014) Awake Craniotomy and Coaching. Open Journal of Medical Psychology, 3, 382-389. doi: 10.4236/ojmp.2014.35040.
References
[1] Brown, P.D., Maurer, M.J., Rummans, T.A., Pollock, B.E., Ballman, K.V., Sloan, J.A., Boeve, B.F., Arusell, R.M., Clark, M. and Buckner J.C. (2005) A Prospective Study of Quality of Life in Adults with Newly Diagnosed High-Grade Gliomas: The Impact of the Extent of Resection on Quality of Life and Survival. Neurosurgery, 57, 495-504.
http://dx.doi.org/10.1227/01.NEU.0000170562.25335.C7 [2] Duffau, H., Lopes, M., Arthuis, F., Bitar, A., Sichez, J.-P., Van Effenterre, R. and Capelle, L. (2005) Contribution of Intraoperative Electrical Stimulations in Surgery of Low Grade Gliomas: A Comparative Study between Two Series without (1985-96) and with (1996-2003) Functional Mapping in the Same Institution. Journal of Neurology, Neurosurgery & Psychiatry, 76, 845-851.
http://dx.doi.org/10.1136/jnnp.2004.048520 [3] Duffau, H. (2012) The Challenge to Remove Diffuse Low-Grade Gliomas While Preserving Brain Functions. Acta Neurochirurgica, 154, 569-574.
http://dx.doi.org/10.1007/s00701-012-1275-7 [4] Penleton, C., Zaidi, H.A., Chaichana, K.L., Raza, S.M., Carson, B.S., Cohen-Gadol, A.A. and Quinones-Hinojosa, A. (2012) Harvey Cushing’s Contributions to Motor Mapping: 1902-1912. Cortex, 48, 7-14.
http://dx.doi.org/10.1016/j.cortex.2010.04.006 [5] Penfield, W. and Rasmussen, T. (1950) The Cerebral Cortex of Man: A Clinical Study of Localization of Function. Macmillan, Oxford. [6] Grossman, R. and Ram, Z. (2014) Awake Craniotomy in Glioma Surgery. European Association of NeuroOncology Magazine, 4, 27-33. [7] Duffau, H. (2010) Awake Surgery for Non-Language Mapping. Neurosurgery, 66, 523-529.
http://dx.doi.org/10.1227/01.NEU.0000364996.97762.73 [8] Szelényi, A., Bello, L., Duffau, H., Fava, E., Feigl, G.C., Galanda, M., Neuloh, G., Signorelli, F. and Sala, F. (2010) Intraoperative Electrical Stimulation in Awake Craniotomy: Methodological Aspects of Current Practice. Neurosurgical Focus, 29, E7.
http://dx.doi.org/10.3171/2009.12.FOCUS09237 [9] Wager, M., Du Boisgueheneuc, F., Pluchon, C., Bouyer, C., Stal, V., Bataille, B., Guillevin, C.M. and Gil, R. (2013) Intraoperative Monitoring of an Aspect of Executive Functions: Administration of the Stroop Test in 9 Adult Patients during Awake Surgery for Resection of Frontal Glioma. Neurosurgery, 72, 169-181.
http://dx.doi.org/10.1227/NEU.0b013e31827bf1d6 [10] Danks, R.A., Rogers, M., Aglio, L.S., Gugino, L.D. and Black, P.M. (1998) Patient Tolerance of Craniotomy Performed with the Patient under Local Anesthesia and Monitored Conscious Sedation. Neurosurgery, 42, 28-36.
http://dx.doi.org/10.1097/00006123-199801000-00006 [11] Wrede, K.H., Stieglitz, L.H., Fiferna, A., Karts, M., Gerganov, V.M., Samii, M., von Gosseln, H.H. and Lüdemann, W.O. (2011) Patient Acceptance of Awake Craniotomy. Clinical Neurology and Neurosurgery, 113, 880-884.
http://dx.doi.org/10.1016/j.clineuro.2011.06.010 [12] Palese, A., Skrap, M., Fachin, M., Visioli, S. and Zannini, L. (2008) The Experience of Patients Undergoing Wake Craniotomy. Cancer Nursing, 31, 168-172.
http://dx.doi.org/10.1097/01.NCC.0000305699.97625.dc [13] Khu, K.J., Doglietto, F., Radovanovic, I., Taleb, F., Mendelsohn, D., Zadeh, G. and Bernstein, M. (2010) Patients’ Perceptions of Awake and Outpatient Craniotomy for Brain Tumor: A Qualitative Study. Journal of Neurosurgery, 112, 1056-1060.
http://dx.doi.org/10.3171/2009.6.JNS09716 [14] Whittle, I.R., Midgley, S., Georges, H., Pringle, A.M. and Taylor, R. (2005) Patient Perceptions of “Awake” Brain Tumour Surgery. Acta Neurochirurgica, 147, 275-277.
http://dx.doi.org/10.1007/s00701-004-0445-7 [15] Nossek, E., Matot, O., Shahar, T., Barzilai, O., Rapoport, Y., Gonen, T., Sela, G., Korn, A., Hayat, D. and Ram, Z. (2013) Failed Awake Craniotomy: A Retrospective Analysis in 424 Patients Undergoing Craniotomy for Brain Tumor. Journal of Neurosurgery, 118, 243-249.
http://dx.doi.org/10.3171/2012.10.JNS12511 [16] Sime, A.M. (1976) Relationship of Preoperative Fear, Type of Coping, and Information Received about Surgery to Recovery from Surgery. Journal of Personality and Social Psychology, 34, 716-724.
http://dx.doi.org/10.1037/0022-3514.34.4.716 [17] Henderson, A.S., Jorm, A.F., Korten, A.E., Jacomb, P., Christensen, H. and Rodgers, B. (1998) Symptoms of Depression and Anxiety during Adult Life: Evidence for a Decline in Prevalence with Age. Psychological Medicine, 28, 1321-1328. [18] D’Angelo, C. Mirijello, A., Leggio, L., Ferrulli, A., Carotenuto, V., Icolaro, N., Miceli, A., D’Angelo, V., Gasbarrini, G. and Addolorato, G. (2008) State and Trait Anxiety and Depression in Patients with Primary Brain Tumors before and after Sugery: 1-Year Longitudinal Study. Journal of Neurosurgery, 108, 281-286.
http://dx.doi.org/10.3171/JNS/2008/108/2/0281 [19] Milian, M., Tatagiba, M. and Feigl, G.C. (2014) Patient Response to Awake Craniotomy—A Summary Overview. Acta Neurochirurgica, 156, 1063-1070.
http://dx.doi.org/10.1007/s00701-014-2038-4 [20] Milian, M., Luerding, R., Ploppa, A., Decker, K., Psaras, T., Tatagiba, M., Gharabaghi, A. and Feigl, G.C. (2013) “Imagine Your Neighbor Mows the Lane”: A Pilot Study of Psychological Sequelae Due to Awake Craniotomy. Journal of Neurosurgery, 118, 1288-1295.
http://dx.doi.org/10.3171/2013.2.JNS121254 [21] Derakshan, N. and Eysenck, M.W. (2009) Anxiety, Processing Efficiency, and Cognitive Performance. European Psychologist, 14, 168-176.
http://dx.doi.org/10.1027/1016-9040.14.2.168 [22] Mahoney, A.M., Dalby, J.T. and King, M. (1998) Cognitive Failures and Stress. Psychological Reports, 82, 1432-1434.
http://dx.doi.org/10.2466/pr0.1998.82.3c.1432 [23] Santini, B., Talacchi, A., Casagrande, F., Casartelli, M., Savazzi, S., Procaccio, F. and Gerosa, M. (2012) Eligibility Criteria and Psychological Profiles in Patient Candidates for Awake Craniotomy: A Pilot Study. Neurosurgery and Anesthesiology, 24, 209-216.
http://dx.doi.org/10.1097/ANA.0b013e3182464aec [24] Hansen, E., Seemann, M., Zech, N., Doenitz, C., Luerding, R. and Brawanski, A. (2013) Awake Craniotomies without Any Sedation: The Awake-Awake-Awake Technique. Acta Neurochirurgica, 155, 1417-1424.
http://dx.doi.org/10.1007/s00701-013-1801-2
[1] Brown, P.D., Maurer, M.J., Rummans, T.A., Pollock, B.E., Ballman, K.V., Sloan, J.A., Boeve, B.F., Arusell, R.M., Clark, M. and Buckner J.C. (2005) A Prospective Study of Quality of Life in Adults with Newly Diagnosed High-Grade Gliomas: The Impact of the Extent of Resection on Quality of Life and Survival. Neurosurgery, 57, 495-504.
http://dx.doi.org/10.1227/01.NEU.0000170562.25335.C7 [2] Duffau, H., Lopes, M., Arthuis, F., Bitar, A., Sichez, J.-P., Van Effenterre, R. and Capelle, L. (2005) Contribution of Intraoperative Electrical Stimulations in Surgery of Low Grade Gliomas: A Comparative Study between Two Series without (1985-96) and with (1996-2003) Functional Mapping in the Same Institution. Journal of Neurology, Neurosurgery & Psychiatry, 76, 845-851.
http://dx.doi.org/10.1136/jnnp.2004.048520 [3] Duffau, H. (2012) The Challenge to Remove Diffuse Low-Grade Gliomas While Preserving Brain Functions. Acta Neurochirurgica, 154, 569-574.
http://dx.doi.org/10.1007/s00701-012-1275-7 [4] Penleton, C., Zaidi, H.A., Chaichana, K.L., Raza, S.M., Carson, B.S., Cohen-Gadol, A.A. and Quinones-Hinojosa, A. (2012) Harvey Cushing’s Contributions to Motor Mapping: 1902-1912. Cortex, 48, 7-14.
http://dx.doi.org/10.1016/j.cortex.2010.04.006 [5] Penfield, W. and Rasmussen, T. (1950) The Cerebral Cortex of Man: A Clinical Study of Localization of Function. Macmillan, Oxford. [6] Grossman, R. and Ram, Z. (2014) Awake Craniotomy in Glioma Surgery. European Association of NeuroOncology Magazine, 4, 27-33. [7] Duffau, H. (2010) Awake Surgery for Non-Language Mapping. Neurosurgery, 66, 523-529.
http://dx.doi.org/10.1227/01.NEU.0000364996.97762.73 [8] Szelényi, A., Bello, L., Duffau, H., Fava, E., Feigl, G.C., Galanda, M., Neuloh, G., Signorelli, F. and Sala, F. (2010) Intraoperative Electrical Stimulation in Awake Craniotomy: Methodological Aspects of Current Practice. Neurosurgical Focus, 29, E7.
http://dx.doi.org/10.3171/2009.12.FOCUS09237 [9] Wager, M., Du Boisgueheneuc, F., Pluchon, C., Bouyer, C., Stal, V., Bataille, B., Guillevin, C.M. and Gil, R. (2013) Intraoperative Monitoring of an Aspect of Executive Functions: Administration of the Stroop Test in 9 Adult Patients during Awake Surgery for Resection of Frontal Glioma. Neurosurgery, 72, 169-181.
http://dx.doi.org/10.1227/NEU.0b013e31827bf1d6 [10] Danks, R.A., Rogers, M., Aglio, L.S., Gugino, L.D. and Black, P.M. (1998) Patient Tolerance of Craniotomy Performed with the Patient under Local Anesthesia and Monitored Conscious Sedation. Neurosurgery, 42, 28-36.
http://dx.doi.org/10.1097/00006123-199801000-00006 [11] Wrede, K.H., Stieglitz, L.H., Fiferna, A., Karts, M., Gerganov, V.M., Samii, M., von Gosseln, H.H. and Lüdemann, W.O. (2011) Patient Acceptance of Awake Craniotomy. Clinical Neurology and Neurosurgery, 113, 880-884.
http://dx.doi.org/10.1016/j.clineuro.2011.06.010 [12] Palese, A., Skrap, M., Fachin, M., Visioli, S. and Zannini, L. (2008) The Experience of Patients Undergoing Wake Craniotomy. Cancer Nursing, 31, 168-172.
http://dx.doi.org/10.1097/01.NCC.0000305699.97625.dc [13] Khu, K.J., Doglietto, F., Radovanovic, I., Taleb, F., Mendelsohn, D., Zadeh, G. and Bernstein, M. (2010) Patients’ Perceptions of Awake and Outpatient Craniotomy for Brain Tumor: A Qualitative Study. Journal of Neurosurgery, 112, 1056-1060.
http://dx.doi.org/10.3171/2009.6.JNS09716 [14] Whittle, I.R., Midgley, S., Georges, H., Pringle, A.M. and Taylor, R. (2005) Patient Perceptions of “Awake” Brain Tumour Surgery. Acta Neurochirurgica, 147, 275-277.
http://dx.doi.org/10.1007/s00701-004-0445-7 [15] Nossek, E., Matot, O., Shahar, T., Barzilai, O., Rapoport, Y., Gonen, T., Sela, G., Korn, A., Hayat, D. and Ram, Z. (2013) Failed Awake Craniotomy: A Retrospective Analysis in 424 Patients Undergoing Craniotomy for Brain Tumor. Journal of Neurosurgery, 118, 243-249.
http://dx.doi.org/10.3171/2012.10.JNS12511 [16] Sime, A.M. (1976) Relationship of Preoperative Fear, Type of Coping, and Information Received about Surgery to Recovery from Surgery. Journal of Personality and Social Psychology, 34, 716-724.
http://dx.doi.org/10.1037/0022-3514.34.4.716 [17] Henderson, A.S., Jorm, A.F., Korten, A.E., Jacomb, P., Christensen, H. and Rodgers, B. (1998) Symptoms of Depression and Anxiety during Adult Life: Evidence for a Decline in Prevalence with Age. Psychological Medicine, 28, 1321-1328. [18] D’Angelo, C. Mirijello, A., Leggio, L., Ferrulli, A., Carotenuto, V., Icolaro, N., Miceli, A., D’Angelo, V., Gasbarrini, G. and Addolorato, G. (2008) State and Trait Anxiety and Depression in Patients with Primary Brain Tumors before and after Sugery: 1-Year Longitudinal Study. Journal of Neurosurgery, 108, 281-286.
http://dx.doi.org/10.3171/JNS/2008/108/2/0281 [19] Milian, M., Tatagiba, M. and Feigl, G.C. (2014) Patient Response to Awake Craniotomy—A Summary Overview. Acta Neurochirurgica, 156, 1063-1070.
http://dx.doi.org/10.1007/s00701-014-2038-4 [20] Milian, M., Luerding, R., Ploppa, A., Decker, K., Psaras, T., Tatagiba, M., Gharabaghi, A. and Feigl, G.C. (2013) “Imagine Your Neighbor Mows the Lane”: A Pilot Study of Psychological Sequelae Due to Awake Craniotomy. Journal of Neurosurgery, 118, 1288-1295.
http://dx.doi.org/10.3171/2013.2.JNS121254 [21] Derakshan, N. and Eysenck, M.W. (2009) Anxiety, Processing Efficiency, and Cognitive Performance. European Psychologist, 14, 168-176.
http://dx.doi.org/10.1027/1016-9040.14.2.168 [22] Mahoney, A.M., Dalby, J.T. and King, M. (1998) Cognitive Failures and Stress. Psychological Reports, 82, 1432-1434.
http://dx.doi.org/10.2466/pr0.1998.82.3c.1432 [23] Santini, B., Talacchi, A., Casagrande, F., Casartelli, M., Savazzi, S., Procaccio, F. and Gerosa, M. (2012) Eligibility Criteria and Psychological Profiles in Patient Candidates for Awake Craniotomy: A Pilot Study. Neurosurgery and Anesthesiology, 24, 209-216.
http://dx.doi.org/10.1097/ANA.0b013e3182464aec [24] Hansen, E., Seemann, M., Zech, N., Doenitz, C., Luerding, R. and Brawanski, A. (2013) Awake Craniotomies without Any Sedation: The Awake-Awake-Awake Technique. Acta Neurochirurgica, 155, 1417-1424.
http://dx.doi.org/10.1007/s00701-013-1801-2