Hypnosis Could Facilitate Awake Surgery of Brain Cancer

A novel hypnosedation technique could offer an alternative for patients undergoing awake surgery for low-grade brain tumors, according to a new study.

Researchers at CHRU Bretonneau (CHRU; Tours, France) and Université François-Rabelais de Tours (UNIV; France) conducted a study involving 37 patients undergoing awake craniotomy for low-grade gliomas between May 2011 and April 2015, in order to assess an innovative hypnosedation procedure. In preparation for hypnosis, the hypnotist met with patients for a short session to teach them how to create a "safe place"—an imaginary place where they can feel safe and effective.

In the operating room, the patient was sedated but remained conscious to be able to communicate; this helped the surgeon navigate safely to the tumor without damaging the eloquent cortex. The patients were placed in a hypnotic trance, which was progressively enhanced during the first stages of surgery, including specific instructions and imagery for each potentially unpleasant or painful step of the surgery. Subjective experiences of hypnosis was assessed using standardized questionnaires.

Hypnosis failed in six patients, who underwent standard "asleep-awake-asleep" anesthesia; another two patients decided not to undergo hypnosis. In all, 28 questionnaires were retrieved from 43 procedures, which revealed a dissociation state in 17 cases, one case of post-traumatic stress disorder (PTSD), and two patients who stated they would not accept a second hypnosedation procedure. Burr hole and bone flap procedures were the most frequently reported unpleasant events (in 15 of 52 events). The study was published the January 2016 issue of Neurosurgery.

“When successful, hypnosis was a reliable and reproducible method for awake surgery, with questionnaire assessments showing little or no negative psychological impact,” concluded lead author Ilyess Zemmoura, MD, PhD, of the UNIV neurosurgical service. “Rather than any measure of individual hypnotizability, the success of hypnosis seemed to be most strongly related to the patients' motivation and determination.”

Low-grade gliomas are cerebral neoplasms that are characterized by an infiltrative growth pattern and progressive transformation to a higher grade of malignancy. Intraoperative direct electric stimulation during awake surgery has proven to be a useful technique, enabling extensive removal while preserving functional integrity of eloquent surrounding brain structures.

Related Links:
CHRU Bretonneau
Université François-Rabelais de Tours