PATIENT TOLERANCE OF CRANIOTOMY PERFORMED WITH THE PATIENT UNDER LOCAL-ANESTHESIA AND MONITORED CONSCIOUS SEDATION

OBJECTIVE: Craniotomy and brain mapping performed with the patient und er local anesthesia and monitored sedation is an important technique t o allow optimal resection of brain tumors or other lesions in close ap position to eloquent cortex. The subjective experience of patients und ergoing [his procedure has not been addressed in the literature. METHO DS: This study formally, intensively, and prospectively assessed the s ubjective experience of 21 consecutive patients undergoing this proced ure. Assessment involved structured interviews at 2 to 3 days postoper atively by a member of the surgical team and at 1 month postoperativel y by a psychiatrist, supplemented by pre-and postoperative assessments of the patients' moods using the brief Profile of Mood States questio nnaire. RESULTS: At the 1-month interview, all patients were entirely comfortable with the experience and there were no indications of adver se psychological sequelae of the event, Ira the eaa ly postoperative i nterview, approximately one-half of the patients reported that the exp erience was entirely satisfactory, without;any intraoperative discomfo rt or pain. One-third of the patients recalled minor difficulties at s ome stage of the experience, and one-fifth recalled moderate difficult ies, An operating room score was devised to quantify the data. Minor t echnical changes are suggested to improve the patients' subjective exp erience. CONCLUSIONS: This series confirmed that this technique is a v ery useful and safe technique far resection of lesions involving eloqu ent cortex that might otherwise be considered inoperable. This procedu re involves a level of stress that remains within the tolerance level of the average adult.