Frati, Alessandro; Pesce, Alessandro; Palmieri, Mauro; Iasanzaniro, Manuela; Familiari, Pietro; et al.
World neurosurgery121: e882-e891. (Jan 2019)
Abstract
BACKGROUND
Hypnosis is a technique that could aid awake surgery protocols. The aim of the present study is to describe the results of a preliminary experience of a cohort of patients operated on with an original protocol of hypnosis-aided awake surgery (HAS).
METHODS
All patients were operated on with the aid of HAS and their data were retrospectively reviewed. A thorough literature review was conducted to compare the results of HAS with the standard awake surgery protocol regarding 1) the incidence of intraoperative pain; 2) the overall incidence of complications; 3) the length of time in which the patients were suitable for intraoperative neuropsychological testing; and 4) the incidence of gross total resection. The comparison presented a notably high statistical impact (1-β = 0.90-0.93 for α = 0.05; effect size, 0.5).
RESULTS
The final cohort comprised 6 patients from our institution and 43 records retrieved in the relevant literature underwent HAS for intrinsic brain tumor treatment. This cohort was compared with cohorts of patients who were considered eligible through a literature review. HAS showed a statistically significant superiority in the first 3 outcome variables, whereas the incidence of gross total resection favored the standard awake approaches.
CONCLUSIONS
According to the results, hypnosis-aided resection of intrinsic brain tumor located in eloquent areas is safe and effective, although dissociation phenomena deserve further investigation to be completely understood.
The HAS protocol overcomes 2 important limitations of standard AsAAs approaches: 1) airway management in the lateral position and 2) the impossibility of proposing surgical intervention to elderly patients or patients affected by severe comorbidities, which are major contraindications to general anesthesia. Furthermore, hypnosis ensures the patient’s spontaneous ventilation, eliminating pulmonary risks caused by oral intubation, such as infections, acute respiratory distress syndrome, 42 43 and risk of transient apnea during the awakening phase.