scholarly journals Impact of Anticipated Awake Surgery on Psychooncological Distress in Brain Tumor Patients

2022 ◽  
Vol 11 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Oliver Radtke ◽  
Daniel Hänggi ◽  
Michael Sabel ◽  
Marion Rapp

BackgroundBrain tumor patients present high rates of distress, anxiety, and depression, in particular perioperatively. For resection of eloquent located cerebral lesions, awake surgery is the gold standard surgical method for the preservation of speech and motor function, which might be accompanied by increased psychological distress. The aim of the present study was to analyze if patients who are undergoing awake craniotomy suffer from increased prevalence or higher scores in distress, anxiety, or depression.MethodsPatients, who were electively admitted for brain tumor surgery at our neurooncological department, were perioperatively screened regarding distress, anxiety, and quality of life using three established self-assessment instruments (Hospital Anxiety and Depression Scale, distress thermometer, and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30-BN20). Screening results were correlated regarding operation technique (awake vs. general anesthesia). Retrospective statistical analyses for nominal variables were conducted using chi-square test. Metric variables were analyzed using the Kruskal–Wallis test, the Mann–Whitney U-test, and independent-samples t-tests.ResultsData from 54 patients (26 male and 28 female) aged 29 to 82 years were available for statistical analyses. A total of 37 patients received primary resection and 17 recurrent tumor resection. Awake surgery was performed in 35 patients. There was no significant difference in awake versus non-awake surgery patients regarding prevalence (of distress (p = 0.465), anxiety (p = 0.223), or depression (p = 0.882). Furthermore, awake surgery had no significant influence on distress thermometer score (p = 0.668), anxiety score (p = 0.682), or depression score (p = 0.630) as well as future uncertainty (p = 0.436) or global health status (p = 0.943). Additionally, analyses revealed that primary or recurrent surgery also did not have any significant influence on the prevalence or scoring of the evaluated items.ConclusionAnalyses of our cohort’s data suggest that planned awake surgery might not have a negative impact on patients concerning the prevalence and severity of manifestation of distress, anxiety, or depression in psychooncological screening. Patients undergoing recurrent surgery tend to demonstrate increased distress, although results were not significant.

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Chao Shen ◽  
Rong Xie ◽  
Xiaoyun Cao ◽  
Weimin Bao ◽  
Bojie Yang ◽  
...  

Background. Intelligence is much important for brain tumor patients after their operation, while the reports about surgical related intelligence deficits are not frequent. It is not only theoretically important but also meaningful for clinical practice.Methods. Wechsler Adult Intelligence Scale was employed to evaluate the intelligence of 103 patients with intracranial tumor and to compare the intelligence quotient (IQ), verbal IQ (VIQ), and performance IQ (PIQ) between the intracerebral and extracerebral subgroups.Results. Although preoperative intelligence deficits appeared in all subgroups, IQ, VIQ, and PIQ were not found to have any significant difference between the intracerebral and extracerebral subgroups, but with VIQ lower than PIQ in all the subgroups. An immediate postoperative follow-up demonstrated a decline of IQ and PIQ in the extracerebral subgroup, but an improvement of VIQ in the right intracerebral subgroup. Pituitary adenoma resection exerted no effect on intelligence. In addition, age, years of education, and tumor size were found to play important roles.Conclusions. Brain tumors will impair IQ, VIQ, and PIQ. The extracerebral tumor resection can deteriorate IQ and PIQ. However, right intracerebral tumor resection is beneficial to VIQ, and transsphenoidal pituitary adenoma resection performs no effect on intelligence.


2015 ◽  
Vol 55 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Riho NAKAJIMA ◽  
Mitsutoshi NAKADA ◽  
Katsuyoshi MIYASHITA ◽  
Masashi KINOSHITA ◽  
Hirokazu OKITA ◽  
...  

2021 ◽  

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.


2020 ◽  
Vol 48 (2) ◽  
pp. E11 ◽  
Author(s):  
Brittany M. Stopa ◽  
Joeky T. Senders ◽  
Marike L. D. Broekman ◽  
Mark Vangel ◽  
Alexandra J. Golby

OBJECTIVEFunctional MRI (fMRI) is increasingly being investigated for use in neurosurgical patient care. In the current study, the authors characterize the clinical use of fMRI by surveying neurosurgeons’ use of and attitudes toward fMRI as a surgical planning tool in neurooncology patients.METHODSA survey was developed to inquire about clinicians’ use of and experiences with preoperative fMRI in the neurooncology patient population, including example case images. The survey was distributed to all neurosurgical departments with a residency program in the US.RESULTSAfter excluding incomplete surveys and responders that do not use fMRI (n = 11), 50 complete responses were included in the final analysis. Responders were predominantly from academic programs (88%), with 20 years or more in practice (40%), with a main area of practice in neurooncology (48%) and treating an adult population (90%). All 50 responders currently use fMRI in neurooncology patients, mostly for low- (94%) and high-grade glioma (82%). The leading decision factors for ordering fMRI were location of mass in dominant hemisphere, location in a functional area, motor symptoms, and aphasia. Across 10 cases, language fMRI yielded the highest interrater reliability agreement (Fleiss’ kappa 0.437). The most common reasons for ordering fMRI were to identify language laterality, plan extent of resection, and discuss neurological risks with patients. Clinicians reported that fMRI results were not obtained when ordered a median 10% of the time and were suboptimal a median 27% of the time. Of responders, 70% reported that they had ever resected an fMRI-positive functional site, of whom 77% did so because the site was “cleared” by cortical stimulation. Responders reported disagreement between fMRI and awake surgery 30% of the time. Overall, 98% of responders reported that if results of fMRI and intraoperative mapping disagreed, they would rely on intraoperative mapping.CONCLUSIONSAlthough fMRI is increasingly being adopted as a practical preoperative planning tool for brain tumor resection, there remains a substantial degree of discrepancy with regard to its current use and presumed utility. There is a need for further research to evaluate the use of preoperative fMRI in neurooncology patients. As fMRI continues to gain prominence, it will be important for clinicians to collectively share best practices and develop guidelines for the use of fMRI in the preoperative planning phase of brain tumor patients.


2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi22-vi22
Author(s):  
Sawane Tejima ◽  
Mai Ueyama ◽  
Daijiro Okamura ◽  
Makoto Ideguchi ◽  
Masao Matsutani

Abstract OBJECTIVE: Brain tumor patients with KPS of 60 to 30 after the initial treatment are not able to spend independent life at home. The goal of this study is to return these patients to their home with minimal family support by delivering intensive rehabilitation to them. Seventy-five brain patients were evaluated every 10 days from the beginning to the end of rehabilitation treatment, according to clinical scales of Functional Independence Measure (FIM) of 1–7 points depending on the degree of independence. The rehabilitation effect was judged by the degree of improvement of 11 out of 13 motor FIM items, excluding stair climbing and bathing movements. When more than half number of the 11 motor FIM items requiring physical assistance (4 points or less) improved up to non-assistance (5 points or more), it was judged as a significant effect. In addition, when all 11 items present with 6 points (independence possible) or more and all 5 of FIM recognition items are 5 points or more (understand the domestic rules), it was judged that the patients acquired independent living ability. RESULTS: 1. Of the 75 patients, 54 (72%) showed a significant effect, and 38 of them (50.7% of the total) aquired independence at home. The acquisition-rate of independent living ability by tumor was 44.7% for 38 malignant gliomas, 53.8% for 13 metastatic tumors, 50% for 14 meningiomas, and 71.4% for 7 vascular tumors, and there was no significant difference between them. 2. The median time to reach the maximum rehabilitation effect was 35 days. CONCLUSION: Intensive rehabilitation for brain tumor patients with KPS of 60 to 30 is effective and should be incorporated into the palliative treatments in the brain tumor treatment guidelines.


2013 ◽  
Vol 119 (5) ◽  
pp. 1107-1111 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Serena De Pellegrin ◽  
Elena d'Avella ◽  
Giorgio Gioffrè ◽  
Marina Munari ◽  
...  

Object The role of parietal areas in number processing is well known. The significance of intraoperative functional mapping of these areas has been only partially explored, however, and only a few discordant data are available in the surgical literature with regard to the right parietal lobe. The purpose of this study was to evaluate the clinical impact of simple calculation in cortical electrostimulation of right-handed patients affected by a right parietal brain tumor. Methods Calculation mapping in awake surgery was performed in 3 right-handed patients affected by high-grade gliomas located in the right parietal lobe. Preoperatively, none of the patients presented with calculation deficits. In all 3 cases, after sensorimotor and language mapping, cortical and intraparietal sulcus areas involved in single-digit multiplication and addition calculations were mapped using bipolar electrostimulation. Results In all patients, different sites of the right parietal cortex, mainly in the inferior lobule, were detected as being specifically related to calculation (multiplication or addition). In 2 patients the intraparietal sulcus was functionally specific for multiplication. No functional sites for language were detected. All sites functional for calculation were spared during tumor resection, which was complete in all cases without postoperative neurological deficits. Conclusions These findings provide intraoperative data in support of an anatomofunctional organization for multiplication and addition within the right parietal area. Furthermore, the study shows the potential clinical relevance of intraoperative mapping of calculation in patients undergoing surgery in the right parietal area. Further and larger studies are needed to confirm these data and assess whether mapped areas are effectively essential for function.


2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii372-iii372
Author(s):  
Hiroyuki Uchida ◽  
Nayuta Higa ◽  
Hajime Yonezawa ◽  
Tatsuki Oyoshi ◽  
Koji Yoshimoto

Abstract Gliomas in children are rarer than in adult, then treatment strategies might vary from facility to facility. We report clinical features and outcome of pediatric glioma in our institution. Twenty-nine patients diagnosed with glioma, exclude ependymoma, 14 boys and 15 girls, among 98 pediatric brain tumor patients treated at Kagoshima University Hospital since 2006 were reviewed histopathology, extent of resection, adjuvant therapy and outcome, etc. Mean age at surgery was 10.4 (S.D. 5.6) years. Median follow-up period was 19.1 months. Histopathological diagnosis comprised 8 pilocytic astrocytoma, 3 ganglioglioma, 2 subependymal giant cell astrocytoma, 5 WHO grade Ⅱ astrocytoma, 8 glioblastoma, and desmoplastic infantile astrocytoma, anaplastic astrocytoma and astroblastoma were one case each. Tumor resection was performed in 24 cases, and 5 cases underwent biopsy. Chemotherapy was performed in 15 cases and irradiation was performed in 9 cases. Out of 5 WHO grade Ⅱ astrocytoma cases, 2 cases underwent biopsy following chemotherapy, 1 case underwent biopsy only and other 1 case underwent total resection. The four cases show long survival ranged from 71 to 136 months without irradiation. All of eight glioblastoma cases show poor prognosis ranged from 8.6 to 26.7 months regardless of chemo-radiotherapy. In management for pediatric brain tumor patients, irradiation is often laid over until recurrence. In WHO grade Ⅱ astrocytoma, the treatment strategy might be reasonable using appropriate chemotherapy even though biopsy cases.


2019 ◽  
Author(s):  
Hannelore Aerts ◽  
Tineke Van Vrekhem ◽  
Lara Stas ◽  
Daniele Marinazzo

Objective: Brain tumor patients may suffer from a range of health-impairing problems reducing their quality of life. To identify potential targets for interventions, we examined the influence of different emotion regulation strategies on emotional well-being and cognitive functioning as indices of quality of life in patients and their caregivers in the early phase of treatment. Methods: To this end, we conducted a longitudinal study, measuring emotion regulation, emotional well-being and cognitive functioning on the day before each patient’s tumor resection (28 patients and 11 caregivers) and several months after neurosurgery (22 patients and 10 caregivers).Results: Results showed emotion regulation strategies are relatively stable from pre- to post-operative assessment. Nevertheless, several associations between emotion regulation strategies and quality of life indices were evident after tumor resection. In particular, our results were largely in line with previous research findings in healthy and other patient populations, corroborating the adaptive character of cognitive reappraisal, whereas suppression and expression of emotions were related to reduced cognitive and affective functioning, respectively.Conclusions: Based on these results, we suggest that further intervention or qualitative studies explore whether therapeutic interventions directed towards mastery of cognitive reappraisal techniques and appropriate expression of emotions could lead to improved long-term adjustment among brain tumor patients and their caregivers.


Author(s):  
Rachel Blue ◽  
Donald K. Detchou ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Michael Spadola ◽  
...  

Abstract Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population. Design This is a retrospective regression analysis. Setting The study conducted at a single, multihospital, urban academic medical center. Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis. Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables. Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed. Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.


2016 ◽  
Vol 4 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Jacqueline B. Stone ◽  
Joanne F. Kelvin ◽  
Lisa M. DeAngelis

Abstract Background Fertility preservation (FP) is an infrequently addressed issue for young adults with primary brain tumors. Given the improved prognosis and enhanced technology in reproductive medicine, more primary brain tumor patients see procreation as feasible, making the discussion of FP increasingly important. The goals of this study were to describe patients who received FP counseling by a fertility nurse specialist (FNS) and determine which sociodemographic and disease-related factors predict acceptance of referral to a reproductive specialist. Methods Institutional review board-approved retrospective review of primary brain tumor patients, ages 18 to 45, who were referred for FP counseling with a FNS from 2009 to 2013. Results Seventy patients were referred for FP counseling: 38 men, 32 women, with a median age of 32 years and median KPS of 90. Eighty-nine percent had gliomas; 58% grade III, 17% grade IV. Sixty-seven percent were referred for counseling at initial diagnosis. Of those referred, 73% accepted referral to a sperm bank (87% of men) or reproductive endocrinologist (56% of women). Patients were more likely to accept referral if they had no prior children (P = .048). There was no statistically significant difference in referral acceptance by age, race/ethnicity, marital status, religion, or tumor grade. After treatment, 3 men conceived naturally, 2 men conceived using banked sperm, and 2 women conceived naturally. Conclusions Despite the historically poor prognosis of patients with primary brain tumors, there is significant interest in FP among these patients, particularly if they have no prior children. Clinicians should develop strategies to incorporate FP counseling into practice.


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