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Undergoing brain surgery while conscious is an understandably terrifying idea. Sometimes, though, it’s necessary, and patients are faced with psychological trauma from the ordeal. Anew study published in Neurosurgery suggests a possible solution in the form of hypnosis.
Dr. Ilyess Zemmoura of the Centre Hospitalier Universitaire de Tours, France, led a team of researchers in the evaluation of a hypnosis technique called hypnosedation as an alternative for patients undergoing surgery awake. The report showed a high rate of successful hypnosisfor patients undergoing surgery for brain cancer (glioma). They believe the technique could be especially valuable for patients with the more advanced forms of brain cancer.
The reason awake craniotomies is that the patient can be sedated but still conscious so as to be able to communicate during their operation. This helps the surgeon safely navigate the brain to the tumor, without damaging the “eloquent cortex,” or critical brain areas involved in movement and language. Zemmoura and colleagues evaluated their hypnosis in 37 patients undergoing this type of surgery, mainly for low-grade gliomas.
They began prepping patients for hypnosis a few weeks before their surgeries. The hybrid anesthesiologist/hypnotist met with the participant for a short hypnosis session and explanation of how to create a “safe space” in their head.
Once in the operating room, patients underwent hypnosis to reach the point of a hypnotic trance, which was progressively enhanced during the first few steps of surgery, including specific instructions and suggested imagery for potentially unpleasant or painful parts of the surgery. When successful, the process was reliable and reproducible, with questionnaire assessments showing little to no negative psychological impacts. Hypnosedation reduced the impact of stressful or unpleasant events during the surgery — pain seemed to decrease as the level of hypnosis deepened.
Hypnosedation is advantageous because it allows the patient to remain awake throughout the entire surgery, avoiding the need to awaken them in the middle of a standard anesthesia. This can be especially challenging in patients with high-grade gliomas — two of whom had successful experiences with hyposedation during the study.
Hypnosis failed in six patients, who underwent the standard asleep-awake-asleep anesthesia instead. Only two patients said they would not choose hypnosedation if they had to undergo a second awake craniotomy. The results of the study overall were encouraging, but the report notes there is no evidence that hypnosedation is superior to standard anesthesia, and that the execution of the technique required “intense involvement and long term training of the whole team, including the patient.”
Source: Zemmoura I, Fournier E, El-Hage W, Jolly V, Destrieux C, Velut S. Hypnosis for Awake Surgery of Low-grade Dliomas: Description of the method and Psychological Assessment. Neurosurgery. 2015.