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Psychological aspects of awake brain surgery in children—interests and risks

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Abstract

Awake brain surgery (ABS) in children remains a subject of controversial debate for the potential psychological limitations that are related to this type of procedure. However, the tolerance and benefits of ABS in adults advocate for increased application of ABS in children. In this study, we report the psychological assessment, evaluation algorithm, and outcome of pediatric patients, who underwent ABS for surgical treatment of lesions in eloquent areas. Psychological selection criteria and the specifications of psychological support are described. A retrospective review and analysis of psychological assessment and psychological outcome of pediatric patients, who underwent ABS between 2005 and 2018 at the Department of pediatric neurosurgery, University of Lyon, France, was performed. Long-term psychological outcomes are reported. ABS was proposed to 18 children aged between 9 and 17 years and their families. After psychological evaluation of the individual patient and their familial surrounding, five boys and 12 girls (n = 17) were accounted eligible for ABS. They underwent asleep-awake-asleep brain surgery with intraoperative testing. In 16 cases, ABS could be performed as planned. Psychological alterations were postoperatively observed in 3 patients, symptoms of a post-traumatic stress disorder in 1 patient. The precise preoperative evaluation of the risk-benefit ratio in children plays a crucial role in anticipating a good psychological outcome. Professional psychological preparation and support of the child and his or her family are the key elements for successful completion of ABS.

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References

  1. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS (2012) Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol 30:2559–2565. https://doi.org/10.1200/jco.2011.38.4818

    Article  Google Scholar 

  2. Freyschlag CF, Duffau H (2014) Awake brain mapping of cortex and subcortical pathways in brain tumor surgery. J Neurosurg Sci 58:199–213

    CAS  PubMed  Google Scholar 

  3. Duffau H (2018) Is non-awake surgery for supratentorial adult low-grade glioma treatment still feasible? Neurosurg Rev 41:133–139. https://doi.org/10.1007/s10143-017-0918-9

    Article  PubMed  Google Scholar 

  4. Meng L, Berger MS, Gelb AW (2015) The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist’s perspective. J Neurosurg Anesthesiol 27:310–317. https://doi.org/10.1097/ana.0000000000000179

    Article  PubMed  Google Scholar 

  5. Gupta DK, Chandra PS, Ojha BK, Sharma BS, Mahapatra AK, Mehta VS (2007) Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study. Clin Neurol Neurosurg 109:335–343. https://doi.org/10.1016/j.clineuro.2007.01.008

    Article  PubMed  Google Scholar 

  6. Sanai N, Berger MS (2018) Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol 15:112–125. https://doi.org/10.1038/nrclinonc.2017.171

    Article  PubMed  Google Scholar 

  7. Akay A, Ruksen M, Cetin HY, Seval HO, Islekel S (2016) Pediatric awake craniotomy for brain lesions. Pediatr Neurosurg 51:103–108. https://doi.org/10.1159/000442988

    Article  PubMed  Google Scholar 

  8. Balogun JA, Khan OH, Taylor M, Dirks P, Der T, Carter Snead Iii O, Weiss S, Ochi A, Drake J, Rutka JT (2014) Pediatric awake craniotomy and intra-operative stimulation mapping. J Clin Neurosci 21:1891–1894. https://doi.org/10.1016/j.jocn.2014.07.013

    Article  PubMed  Google Scholar 

  9. Everett LL, van Rooyen IF, Warner MH, Shurtleff HA, Saneto RP, Ojemann JG (2006) Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases. Paediatr Anaesth 16:338–342. https://doi.org/10.1111/j.1460-9592.2005.01697.x

    Article  PubMed  Google Scholar 

  10. McClain CD, Landrigan-Ossar M (2014) Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin 32:83–100. https://doi.org/10.1016/j.anclin.2013.10.009

    Article  PubMed  Google Scholar 

  11. Riquin E, Martin P, Duverger P, Menei P, Delion M (2017) A case of awake craniotomy surgery in an 8-year-old girl. Childs Nerv Syst 33:1039–1042. https://doi.org/10.1007/s00381-017-3463-5

    Article  PubMed  Google Scholar 

  12. Sheshadri V, Chandramouli BA (2016) Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report. J Clin Anesth 32:199–202. https://doi.org/10.1016/j.jclinane.2016.03.009

    Article  PubMed  Google Scholar 

  13. Delion M, Terminassian A, Lehousse T, Aubin G, Malka J, N'Guyen S, Mercier P, Menei P (2015) Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area. World Neurosurg 84:1645–1652. https://doi.org/10.1016/j.wneu.2015.06.073

    Article  PubMed  Google Scholar 

  14. Grill J, Viguier D, Kieffer V, Bulteau C, Sainte-Rose C, Hartmann O, Kalifa C, Dellatolas G (2004) Critical risk factors for intellectual impairment in children with posterior fossa tumors: the role of cerebellar damage. J Neurosurg 101:152–158. https://doi.org/10.3171/ped.2004.101.2.0152

    Article  PubMed  Google Scholar 

  15. Nazemi KJ, Butler RW (2011) Neuropsychological rehabilitation for survivors of childhood and adolescent brain tumors: a view of the past and a vision for a promising future. J Pediatr Rehabil Med 4:37–46. https://doi.org/10.3233/prm-2011-0151

    Article  PubMed  Google Scholar 

  16. Vago C, Bulgheroni S, Usilla A, Biassoni V, Serra A, Gentile S, Ajovalasit D, Leonardi M, Massimino M, Fidani P, Riva D (2011) Adaptive functioning in children in the first six months after surgery for brain tumours. Disabil Rehabil 33:953–960. https://doi.org/10.3109/09638288.2010.520804

    Article  PubMed  Google Scholar 

  17. Riquin E, Dinomais M, Malka J, Lehousse T, Duverger P, Menei P, Delion M (2017) Psychiatric and psychological impact of surgery while awake in children for resection of brain tumors. World Neurosurg 102:400–405. https://doi.org/10.1016/j.wneu.2017.03.017

    Article  PubMed  Google Scholar 

  18. Beez T, Boge K, Wager M, Whittle I, Fontaine D, Spena G, Braun S, Szelenyi A, Bello L, Duffau H, Sabel M (2013) Tolerance of awake surgery for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir 155:1301–1308. https://doi.org/10.1007/s00701-013-1759-0

    Article  PubMed  Google Scholar 

  19. Bajunaid KM, Ajlan AM (2015) Awake craniotomy. A patient’s perspective. Neurosciences (Riyadh, Saudi Arabia) 20:248–252. https://doi.org/10.17712/nsj.2015.3.20140548

    Article  Google Scholar 

  20. Goebel S, Nabavi A, Schubert S, Mehdorn HM (2010) Patient perception of combined awake brain tumor surgery and intraoperative 1.5-T magnetic resonance imaging: the Kiel experience. Neurosurgery 67:594–600; discussion 600. https://doi.org/10.1227/01.neu.0000374870.46963.bb

    Article  PubMed  Google Scholar 

  21. Wrede KH, Stieglitz LH, Fiferna A, Karst M, Gerganov VM, Samii M, von Gosseln HH, Ludemann WO (2011) Patient acceptance of awake craniotomy. Clin Neurol Neurosurg 113:880–884. https://doi.org/10.1016/j.clineuro.2011.06.010

    Article  PubMed  Google Scholar 

  22. Whittle IR, Midgley S, Georges H, Pringle AM, Taylor R (2005) Patient perceptions of “awake” brain tumour surgery. Acta Neurochir 147:275–277; discussion 277. https://doi.org/10.1007/s00701-004-0445-7

    Article  CAS  PubMed  Google Scholar 

  23. Howie E, Bambrough J, Karabatsou K, Fox JR (2016) Patient experiences of awake craniotomy: an interpretative phenomenological analysis. J Health Psychol 21:2612–2623. https://doi.org/10.1177/1359105315581513

    Article  PubMed  Google Scholar 

  24. Klimek M, van der Horst PH, Hoeks SE, Stolker RJ (2018) Quality and quantity of memories in patients who undergo awake brain tumor resection. World Neurosurg 109:e258–e264. https://doi.org/10.1016/j.wneu.2017.09.158

    Article  PubMed  Google Scholar 

  25. Palese A, Skrap M, Fachin M, Visioli S, Zannini L (2008) The experience of patients undergoing awake craniotomy: in the patients’ own words. A qualitative study. Cancer Nurs 31:166–172. https://doi.org/10.1097/01.NCC.0000305699.97625.dc

    Article  PubMed  Google Scholar 

  26. Milian M, Luerding R, Ploppa A, Decker K, Psaras T, Tatagiba M, Gharabaghi A, Feigl GC (2013) “Imagine your neighbor mows the lawn”: a pilot study of psychological sequelae due to awake craniotomy: clinical article. J Neurosurg 118:1288–1295. https://doi.org/10.3171/2013.2.jns121254

    Article  PubMed  Google Scholar 

  27. Milian M, Tatagiba M, Feigl GC (2014) Patient response to awake craniotomy - a summary overview. Acta Neurochir 156:1063–1070. https://doi.org/10.1007/s00701-014-2038-4

    Article  PubMed  Google Scholar 

  28. Santini B, Talacchi A, Casagrande F, Casartelli M, Savazzi S, Procaccio F, Gerosa M (2012) Eligibility criteria and psychological profiles in patient candidates for awake craniotomy: a pilot study. J Neurosurg Anesthesiol 24:209–216. https://doi.org/10.1097/ANA.0b013e3182464aec

    Article  PubMed  Google Scholar 

  29. Ari AB, Peri T, Margalit D, Galili-Weisstub E, Udassin R, Benarroch F (2018) Surgical procedures and pediatric medical traumatic stress (PMTS) syndrome: assessment and future directions. J Pediatr Surg 53:1526–1531. https://doi.org/10.1016/j.jpedsurg.2017.10.043

    Article  PubMed  Google Scholar 

  30. Ben Ari A, Margalit D, Udassin R, Benarroch F (2018) Traumatic stress among school-aged pediatric surgery patients and their parents. Eur J Pediatr Surg. https://doi.org/10.1055/s-0038-1660449

    PubMed  Google Scholar 

  31. Pasquet A (1954) Combined regional and general anesthesia for craniotomy and cortical exploration. II Anesthetic considerations. Curr Res Anesth Analg 33:156–164

    Article  CAS  Google Scholar 

  32. Berger MS (1996) The impact of technical adjuncts in the surgical management of cerebral hemispheric low-grade gliomas of childhood. J Neuro-Oncol 28:129–155

    Article  CAS  Google Scholar 

  33. Klimek M, Verbrugge SJ, Roubos S, van der Most E, Vincent AJ, Klein J (2004) Awake craniotomy for glioblastoma in a 9-year-old child. Anaesthesia 59:607–609. https://doi.org/10.1111/j.1365-2044.2004.03675.x

    Article  CAS  PubMed  Google Scholar 

  34. Anthony SJ, Robertson T, Selkirk E, Dix D, Klaassen RJ, Sung L, Klassen AF (2019) The social impact of early psychological maturity in adolescents with cancer. Psycho-oncology 28:586–592. https://doi.org/10.1002/pon.4982

    Article  PubMed  Google Scholar 

  35. Jones CM, Foli KJ (2018) Maturity in adolescents with type 1 diabetes mellitus: a concept analysis. J Pediatr Nurs 42:73–80. https://doi.org/10.1016/j.pedn.2018.07.004

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the entire Department of Pediatric Neurosurgery, especially all nursing and OR personal, as well as our physiotherapists, who contributed significantly to this work. In addition, we would like to transmit our gratitude to Aude Margier of the Department of Medical Psychology, who contributed to the evaluation and interpretation of the psychological results and whose reflections throughout repetitive discussions allowed to develop the key questions for this study and accordingly optimized the evaluation process of the patient outcomes.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France

    Ludivine Huguet, Laura-Nanna Lohkamp, Pierre-Aurelien Beuriat, Alexandru Szathmari, Carmine Mottolese & Federico Di Rocco

  2. Department of Medical Psychology, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France

    Ludivine Huguet

  3. Division of Pediatric Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada

    Laura-Nanna Lohkamp

  4. Center for Cognitive Neuroscience, Lyon, France

    Pierre-Aurelien Beuriat & Michel Desmurget

  5. Department of Anesthesia and Critical Care Medicine, Hôpital Neurologique Pierre Wertheimer, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France

    Lionel Bapteste

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  1. Ludivine Huguet
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Correspondence to Federico Di Rocco.

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With respect to this study, there are no conflicts of interest to declare. There was no external funding obtained for the conduction of the study.

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Huguet, L., Lohkamp, LN., Beuriat, PA. et al. Psychological aspects of awake brain surgery in children—interests and risks. Childs Nerv Syst 36, 273–279 (2020). https://doi.org/10.1007/s00381-019-04308-8

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  • DOI: https://doi.org/10.1007/s00381-019-04308-8

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