Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial.

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.

Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience.

BACKGROUND: Hypnosis is a technique that could aid awake surgery protocols. The aim of the present study is to describe the results of a preliminary experience of a cohort of patients operated on with an original protocol of hypnosis-aided awake surgery (HAS). METHODS: All patients were operated on with the aid of HAS and their data were retrospectively reviewed. A thorough literature review was conducted to compare the results of HAS with the standard awake surgery protocol regarding 1) the incidence of intraoperative pain; 2) the overall incidence of complications; 3) the length of time in which the patients were suitable for intraoperative neuropsychological testing; and 4) the incidence of gross total resection. The comparison presented a notably high statistical impact (1-ß = 0.90-0.93 for α = 0.05; effect size, 0.5). RESULTS: The final cohort comprised 6 patients from our institution and 43 records retrieved in the relevant literature underwent HAS for intrinsic brain tumor treatment. This cohort was compared with cohorts of patients who were considered eligible through a literature review. HAS showed a statistically significant superiority in the first 3 outcome variables, whereas the incidence of gross total resection favored the standard awake approaches. CONCLUSIONS: According to the results, hypnosis-aided resection of intrinsic brain tumor located in eloquent areas is safe and effective, although dissociation phenomena deserve further investigation to be completely understood.