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Journal of Neurosurgical Sciences 2021 May 03

DOI: 10.23736/S0390-5616.21.05323-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Alteration of anxiety and depression after awake craniotomy: a prospective study on patients with language eloquent high-grade glioma

Mohammad RAHMANI 1, Kasra HENDI 1, Hamideh AJAM 2, Amirhossein LARIJANI 1, Mostafa FARZIN 1, 3, Mohammad ARBABI 2, Ahmad POUR-RASHIDI 1, Maysam ALIMOHAMADI 1, 4

1 Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; 2 Neuropsychiatry Section, Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran; 3 Radio-Oncology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; 4 Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran


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BACKGROUND: Awake Craniotomy (AC) is considered to achieve maximal safe resection of language eloquent gliomas. Impact of AC on the psychological status of patients (mainly anxiety, and post-traumatic stress disorder: PTSD) is a potential concern. Despite the studies reporting the early postoperative patient’s perception after AC, this study has been performed to quantitatively evaluate the long term influence of AC on the level of anxiety/depression after surgery.
METHODS: Patients who underwent AC for suspected language eloquent high-grade glioma were enrolled in this study. The anxiety, depression and PTSD of the patients were evaluated via hospital anxiety and depression scale (HADS) one week before and 1 and 6 months after the operation. PTSD symptoms were assessed according to the DSM-V checklist and confirmed by a structured clinical interview for DSM-V.
RESULTS: Twenty-eight patients (22 men, 6 women) with the mean age of 39.2 years were enrolled. The mean preoperative depressive and anxiety score was 4.9±5.9 and 7.7±5.8 respectively. One month after surgery they were 6±4.9 and 7.4±6.2 and at 6 months’ follow-up 5.5±5.1 and 5.4±4.2 respectively. There was no statistically significant trend for alterations of the anxiety/depression levels before and after surgery. Female patients, those suspected to have glioblastoma and patients presenting with speech disturbance had remarkably higher preoperative anxiety levels. Three patients had PTSD symptoms 3 months after AC while at 6 months there was no indication of PTSD. The decremental trend of PTSD score within 6 months was statistically significant.
CONCLUSIONS: Judicious application of AC is not associated with an escalation of the anxiety/depression level among the patients. Even patients with high preoperative anxiety levels could be managed with AC without severe psychological deterioration.


KEY WORDS: Anxiety; Awake craniotomy; Depression; Glioma; Language; Eloquent brain region

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