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Awake Craniotomy in a Patient with Previously Diagnosed Post-Traumatic Stress Disorder.
Lina Marenco-Hillembrand1, Paola Suarez-Meade1, David S Sabsevitz1
1Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurgery
|April 13, 2020
Summary
Awake craniotomy (AC) is feasible for patients with post-traumatic stress disorder (PTSD). Careful planning and a multidisciplinary approach ensure patient safety and positive outcomes during brain surgery.
Area of Science:
- Neurosurgery
- Neuroscience
- Psychiatry
Background:
- Awake craniotomy (AC) with brain mapping is a standard procedure for resecting brain lesions near eloquent areas.
- Post-traumatic stress disorder (PTSD) has been considered a contraindication for AC due to potential patient non-cooperation.
- This case study examines the management of a patient with PTSD undergoing AC for glioma removal.
Observation:
- A 34-year-old male veteran with a history of PTSD underwent AC for a low-grade insular glioma.
- Preoperative assessments identified PTSD triggers and guided procedural explanations.
- The intraoperative setting was modified, and an asleep-awake-asleep anesthetic protocol was used.
Findings:
- The patient tolerated the AC procedure well, with no postoperative neurological or cognitive deficits.
- The patient reported no worsening of PTSD symptoms and viewed the AC experience positively at 1-month follow-up.
Implications:
- Multidisciplinary teams, thorough preoperative education, and trigger identification are crucial for safe AC in PTSD patients.
- Controlled intraoperative environments can mitigate risks associated with AC in patients with PTSD.
- This approach demonstrates the successful application of AC in a complex patient population, expanding surgical options.
