儿童和青少年清醒颅内手术引发的恐慌和担忧发生频率如何?
How often do awake craniotomies in children and adolescents lead to panic and worry?
发表日期:2023 Aug 23
作者:
K Daniel O'Leary, Anastasia J Philippopoulos, Alexis Koslofsky, Yashna Ahmed
来源:
Brain Structure & Function
摘要:
清醒脑手术 (AC) 是成人处理优势脑区脑肿瘤切除的首选治疗方法,但对其对儿童和青少年心理影响的了解还不够。手术期患者的不成熟和合作困难可能导致术后心理影响,如焦虑、恐慌和担忧。在本研究中,我们考察了8项对18岁以下患者 (N = 85) 进行 AC 的研究,注意排除标准、采用的干预措施和实施的心理评估。初步评估主要是为了确定患者是否适合进行 AC,而不是限制年龄。没有使用标准化的干预措施来减少与 AC 相关的焦虑。干预范围从未指定到暴露于手术室录像、催眠、与心理学家和语言治疗师多次会面、与手术团队广泛会面、以及对手术室院落进行详尽暴露。除了少数例外,没有标准化的术前和术后 AC 心理影响评估。定性评估表明,大多数儿童和青少年表现出良好的耐受性,但一项研究表明,手术后学校出勤存在不利影响。考虑到大多数 AC 团队都配备了心理学家,有必要使用标准化的焦虑、创伤和担忧测量工具,以及针对 AC 的测量工具,如复学时间、手术后对 MRI 的担忧和手术后功能的自我评估,进行术前和术后的心理评估。总之,明显需要对 AC 患者进行综合的心理评估。© 2023. 作者。
Awake craniotomy (AC) is the treatment of choice for the resection of brain tumors within eloquent brain regions for adults, but not much is known about its psychological impact on children and adolescents. Patient immaturity and difficulty in cooperating during surgery could result in psychological sequelae postoperatively, such as anxiety, panic, and worry.In this review, we examined eight studies assessing AC performed on patients under 18 years of age (N = 85), noting exclusion criteria, interventions used, and psychological assessments implemented.Initial assessments of cognitive functioning and maturity were conducted primarily to determine patient eligibility for AC instead of an age restriction. No standardized interventions were used to minimize anxiety associated with AC. Interventions ranged from almost nothing specified to exposure to videos of the operating room, hypnosis, repeated meetings with psychologists and speech therapists, extensive meetings with the surgery team, and thorough exposure to the operating room theater. With a few exceptions, there were no standardized pre- and post-AC assessments of psychological sequelae. Qualitative evaluations indicated that most children and adolescents tolerated AC well, but one study indicated detrimental effects on school attendance postoperatively.Given that most AC teams have a psychologist, it seems desirable to have pre- and post-AC psychological assessments using standardized measures of anxiety, trauma, and worry, as well as measures tailored to AC, such as time to return to school, worry about MRIs following surgery, and self-assessment of post-surgery functioning. In short, comprehensive psychological assessment of AC patients is clearly needed.© 2023. The Author(s).