Awake Craniotomy in a Patient with Previously Diagnosed Post-Traumatic Stress Disorder
Author links open overlay panelLinaMarenco-Hillembrand1PaolaSuarez-Meade1David S.Sabsevitz1Bruce J.Leone2Kaisorn L.Chaichana1
1
Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
2
Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
Received 1 February 2020, Accepted 27 March 2020, Available online 9 April 2020.
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Background
Awake craniotomy (AC) with brain mapping has been successfully used for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough presurgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery because these patients may be less cooperative to tolerate AC. Here we present the management of a patient with PTSD who underwent an AC using a multidisciplinary team for removal of a dominant hemisphere low-grade insular glioma with speech, motor, and cognitive mapping.
Case Description
A 34-year-old right-handed male military veteran with a previous history of PTSD was scheduled for a left AC for resection of a low-grade insular glioma. He underwent preoperative neurocognitive assessment with a neuropsychologist and clinic visit with a neurosurgeon to characterize his PTSD and potential triggers, explain the procedure in a stepwise fashion, and address any concerns. The intraoperative environment was modified to minimize triggering stimuli, and an asleep-awake-asleep anesthetic protocol was followed. The patient tolerated the procedure well without any postoperative neurologic deficits including cognitive deficits. At 1-month follow-up, he denied any worsening of his PTSD symptoms and recalls the AC as a positive experience.
Conclusions
With a multidisciplinary team, adequate preoperative education, detailed clinical interview to identify triggers, and a controlled intraoperative environment, awake surgery can be carried out safely in a patient with PTSD.
Author links open overlay panelLinaMarenco-Hillembrand1PaolaSuarez-Meade1David S.Sabsevitz1Bruce J.Leone2Kaisorn L.Chaichana1
1
Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
2
Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
Received 1 February 2020, Accepted 27 March 2020, Available online 9 April 2020.
crossmark-logo
Show less
https://doi.org/10.1016/j.wneu.2020.03.194Get rights and content
Background
Awake craniotomy (AC) with brain mapping has been successfully used for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough presurgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery because these patients may be less cooperative to tolerate AC. Here we present the management of a patient with PTSD who underwent an AC using a multidisciplinary team for removal of a dominant hemisphere low-grade insular glioma with speech, motor, and cognitive mapping.
Case Description
A 34-year-old right-handed male military veteran with a previous history of PTSD was scheduled for a left AC for resection of a low-grade insular glioma. He underwent preoperative neurocognitive assessment with a neuropsychologist and clinic visit with a neurosurgeon to characterize his PTSD and potential triggers, explain the procedure in a stepwise fashion, and address any concerns. The intraoperative environment was modified to minimize triggering stimuli, and an asleep-awake-asleep anesthetic protocol was followed. The patient tolerated the procedure well without any postoperative neurologic deficits including cognitive deficits. At 1-month follow-up, he denied any worsening of his PTSD symptoms and recalls the AC as a positive experience.
Conclusions
With a multidisciplinary team, adequate preoperative education, detailed clinical interview to identify triggers, and a controlled intraoperative environment, awake surgery can be carried out safely in a patient with PTSD.
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