gms | German Medical Science

Objective: Although it has been described that awake neurosurgical procedures are well tolerated, the long-term occurrence of general psychological sequelae have not yet been investigated. We assessed the frequency and the effects of psychological symptoms after an awake craniotomy on health related quality of life (HRQoL).

Method: Sixteen patients undergoing an awake surgery were surveyed with a self-developed questionnaire, the posttraumatic stress disorder inventory for awake surgery patients (PTSD-ASP) which adopts the core components of the posttraumatic stress disorder (PTSD) criteria. The mean time between surgery and data collection was 97.3±93.2 weeks. HRQoL was assessed with the SF-36 questionnaire.

Results: 44% of the patients stated that they had either repetitive distressing recollections or dreams related to the awake surgery, 18.8% stated persistent avoidance of stimuli associated with the awake surgery. Symptoms of increased arousal occurred in 62.5%. Two patients presented with postoperative psychological sequelae resembling PTSD symptoms. A PTSD was not present in any patient. Younger age at surgery and female gender were risk factors for symptoms of increased arousal. The experience of intense anxiety during awake surgery seems to favour the development of postsurgical PTSD symptoms, while recurrent distressing recollections particularly affect HRQoL negatively.

Conclusions: In many cases awake craniotomy is necessary to preserve language and motor function. However, in some cases awake craniotomy can lead to postoperative psychological sequelae resembling PTSD symptoms. Therefore, possible long-term effects of an awake surgery should be considered and discussed with the patient when planning this type of surgery.