Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation

OBJECTIVE: Craniotomy and brain mapping performed with the patient under local anesthesia and monitored sedation is an important technique to allow optimal resection of brain tumors or other lesions in close apposition to eloquent cortex. The subjective experience of patients undergoing [his procedure has not been addressed in the literature. METHODS: This study formally, intensively, and prospectively assessed the subjective experience of 21 consecutive patients undergoing this procedure. Assessment involved structured interviews at 2 to 3 days postoperatively by a member of the surgical team and at 1 month postoperatively by a psychiatrist, supplemented by pre-and postoperative assessments of the patients' moods using the brief Profile of Mood States questionnaire. RESULTS: At the 1-month interview, all patients were entirely comfortable with the experience and there were no indications of adverse psychological sequelae of the event, Ira the eaa ly postoperative interview, approximately one-half of the patients reported that the experience was entirely satisfactory, without;any intraoperative discomfort or pain. One-third of the patients recalled minor difficulties at some stage of the experience, and one-fifth recalled moderate difficulties, An operating room score was devised to quantify the data. Minor technical changes are suggested to improve the patients' subjective experience. CONCLUSIONS: This series confirmed that this technique is a very useful and safe technique far resection of lesions involving eloquent cortex that might otherwise be considered inoperable. This procedure involves a level of stress that remains within the tolerance level of the average adult.