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Patient selection

Apart from anatomical criteria, this article discusses which psychological criteria a person needs to have to qualify for an awake brain surgery.
Dr Wagemakers in an consultation
© University of Groningen
Apart from the tumour type that needs to be assessed for eligibility, the patient should meet various criteria for suitability and eligibility for the long and possibly exhausting procedure that the patient is facing in an awake brain surgery. The following points are the challenges for the patient that he or she must be aware of to decide whether the patient is suitable or not for awake surgery.

Stress and anxiety

And then we will wake you up, once we opened your skull and you will have to perform tasks for us, while you try not to move!

The prospect of the exhausting and challenging procedure can cause stress and anxiety in a patient. While this sounds like a dramatic way of putting it, it is the reality of what the patient needs to go through. Not all patients are sufficiently resilient to cope with this stress.

Preparation plays a big role here: the more the patient knows about what is ahead, the less surprised he or she will be and the less likely to panic on the operation table.

Pain and discomfort

The awake procedure will require the patient to lay still for up to 3 hours. Lying still for this long causes aches and pains in the muscles and tendons. Furthermore, the patient’s head is fixated in a head clamp. Coughing causes the brain to swell and can be dangerous, especially if the surgeon is busy with a delicate procedure. So the patient needs to suppress this urge, indicate to the staff when the patient needs to cough and only do so when it is safe.

In fact most movements are either undesirable or not possible. Some of the medications can cause an itchy nose, and if this is the case, the staff present must scratch it for the patient. No patient will be excluded on the basis of being unable to suppress movement, but again, preparation and practice is the key. The patient is asked to practice lying still in a uncomfortable position for 1-2 hours at home, to get an idea of what the patient will go through in the OR.

Immense effort and concentration are needed

Immense effort and concentration are needed as the patient is required to perform linguistic tasks during all this for up to 3 hours. In addition to being kept in an uncomfortable position, the patient will have to be as focused as possible during the awake procedure. His or her feedback is essential to map the positive and negative regions for language in the brain. Without the patient being able to give this accurate feedback, the mapping procedure could fail.

Therefore, patients who are confused, or too impaired by the tumour, or are unable to focus for such a long period might not be eligible for an ABS. Once again, the language testing part can be trained to some extent during a mock situation as well.

During the consultations, the surgical team does not only inform the patient of what will happen, but they will try to establish if the patient mentally qualifies for the procedure and how to prepare him or her in the best possible way.

Part of the team

The goal of the preoperative consultations are to make sure the patient understands: the patient will be part of the team! Making him or her feel as comfortable as possible, and including the patient as a team member in the preparations will assure that he or she can take out his part in this group effort to achieve a successful operation.

© University of Groningen
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Language Testing During Awake Brain Surgery

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