The experience of patients undergoing awake craniotomy for intracranial masses: expectations, recall, satisfaction and functional outcome

Abstract

Introduction. Awake craniotomy is a well-established neurosurgical technique for lesions involving eloquent cortex, however, there is little information regarding patients' subjective experience with this type of surgery. Here we explore the expectations, recall, satisfaction and functional outcome of patients undergoing awake craniotomy.

Methods. Three semi-structured interviews using closed- and open-ended questions were conducted with each of 26 consecutive patients (17 males, 9 females; aged 16–78 years) who underwent their first awake craniotomy between 2007 and 2009. Seven patients were interviewed retrospectively, 19 prospectively. Clinical data are included.

Results. The following themes emerged from this study: (1) most patients demonstrated a good understanding of the rationale behind awake craniotomy; (2) patients felt the asleep–awake–asleep anaesthetic protocol used in this series was appropriate; (3) patients' confidence and preparedness for surgery was high, attributed to preparation by the surgical team. Seven of 26 (27%) patients had no recollection of being awake. Most patients had a positive anaesthetic and surgical experience, while a minority of patients reported experiencing more than slight pain (2/26; 8%) and discomfort (3/26; 12%), fear (4/26; 15%) or claustrophobia (1/26; 4%) intra-operatively. At follow-up (6 weeks post-operatively), most patients were functionally unimpaired; there was only one permanent neurological complication of surgery. We found that 24/26 (92%) patients were satisfied with their experience; one patient had no opinion and another one was unsatisfied. Five of 26 (19%) patients still reported more than slight discomfort, and 3/26 (12%) reported more than slight pain attributable to the surgery. A summary of the English peer-reviewed literature on the patient experience of awake craniotomy is also incorporated.

Conclusions. This study confirms that awake craniotomy using the ‘asleep–awake–asleep’ anaesthetic protocol is a generally safe and well-tolerated procedure associated overall with satisfactory patients' experiences and neurological outcomes.

Key words:

• Awake craniotomy
• brain tumour
• cerebrovascular disease
• outcome
• patient experience

Acknowledgements

The manuscript was written by SM and VGK. All awake procedures were carried out by the corresponding author (VGK) and anaesthetic team (DD, TB, JF and LZ). The manuscript was edited by DD, JF and LZ. The authors wish to thank the theatre, intensive care unit and neurosurgical nursing staff for their patient care. For this particular study frequently utilising additional comprehensive MRI pre-operative imaging protocols, the enthusiastic support of radiology staff at St. Vincents Public Hospital (Sydney), Symbion Imaging Research Centre (Sydney) and the Canberra Hospital is also gratefully acknowledged, as is the assistance of Dr. Nada Chandran, Dr. Prashanth Rao, Dr. Peter Mews, Ms. Di Lane, Mr. Andrew Janke and Dr. Joga Chaganti. Last, but by no means least, we are sincerely grateful to each and every patient who agreed to participate in this study.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.