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. 2023 Feb 1;92(2):225-240.
doi: 10.1227/neu.0000000000002224. Epub 2022 Nov 18.

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

Mohammad Mofatteh  1 , Mohammad Sadegh Mashayekhi  2 , Saman Arfaie  3   4 , Yimin Chen  5 , Kasra Hendi  6 , Angela Tian Hui Kwan  7 , Faraz Honarvar  8 , Arad Solgi  9 , Xuxing Liao  10   11 , Keyoumars Ashkan  12   13   14   15
Affiliations

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

Mohammad Mofatteh et al. Neurosurgery. .

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-awake-awake 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.

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Figures

FIGURE.
FIGURE.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart demonstrating search, screen, inclusion, and exclusion process for this study.
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References

    1. Duffau H, Lopes M, Arthuis F, et al. 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. J Neurol Neurosurg Psychiatry. 2005;76(6):845-851. - PMC - PubMed
    1. Bello L, Gallucci M, Fava M, et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery. 2007;60(1):67-80; discussion 80-82. - PubMed
    1. Kim SS, McCutcheon IE, Suki D, et al. Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery. 2009;64(5):836-845; discussion 345-346. - PubMed
    1. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2559-2565. - PubMed
    1. Ruis C. Monitoring cognition during awake brain surgery in adults: a systematic review. J Clin Exp Neuropsychol. 2018;40(10):1081-1104. - PubMed

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