Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T21:42:42.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Challenges with Awake Craniotomy for Tumor

Published online by Cambridge University Press:  02 December 2014

Brandon Kirsch  and
Mark Bernstein
Brandon Kirsch
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
Mark Bernstein*
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
*
Toronto Western Hospital, West Wing, 4W451, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Awake brain surgery is useful for the treatment of a number of conditions such as epilepsy and brain tumor, as well as in functional neurosurgery. Several studies have been published regarding clinical results and outcomes of patients who have undergone awake craniotomy but few have dealt with related ethical issues.

Objective:

The authors undertake to explore broadly the ethical issues surrounding awake brain surgery for tumor resection to encourage further consideration and discussion.

Methods:

Based on a review of the literature related to awake craniotomy and in part from the personal experience of the senior author, we conducted an assessment of the ethical issues associated with awake brain tumor surgery.

Results:

The major ethical issues identified relate to: (1) lack of data; (2) utilization; (3) conflict of interest; (4) informed consent; (5) surgical innovation; and (6) surgical training.

Conclusion:

The authors respectfully suggest that the selection of patients for awake craniotomy needs to be monitored according to more consistent, objective standards in order to avoid conflicts of interest and potential harm to patients.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 1 , January 2012 , pp. 78 - 82
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1Serletis, D, Bernstein, M.Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg. 2007;107:1–6.Google Scholar
2July, J, Manninen, P, Lai, J, Yao, Z, Bernstein, M.The history of awake craniotomy for brain tumor and its spread into Asia. Surg Neurol. 2009;71:621–4.Google Scholar
3Horsley, V.Remarks on consecutive cases of operations upon the brain and cranial cavity to illustrate the details and safety of the method employed. Br Med J. 1887;1:863–5.Google Scholar
4Taylor, MD, Bernstein, M.Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg. 1999;90:35–41.Google Scholar
5Danks, RA, Aglio, LS, Gugino, LD, Black, PM.Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. J Neurooncol. 2000;49:131–9.CrossRefGoogle ScholarPubMed
6Reulen, HJ, Schmid, UD, Ilmberger, J, Eisner, W, Bise, K.[Tumor surgery of the speech cortex in local anesthesia. Neuropsychological and neurophysiological monitoring during operations in the dominant hemisphere]. Nervenarzt. 1997;68: 813–24.Google Scholar
7Blanshard, HJ, Chung, F, Manninen, PH, Taylor, MD, Bernstein, M.Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth Analg. 2001;92:89–94.Google Scholar
8Boulton, M, Bernstein, M.Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg. 2008;108: 649–54.Google Scholar
9Grundy, PL, Weidmann, C, Bernstein, M.Day-case neurosurgery for brain tumours: the early United Kingdom experience. Br J Neurosurg. 2008;22:360–7.Google Scholar
10Purzner, T, Purzner, J, Massicotte, EM, Bernstein, M.Outpatient brain tumor surgery and spinal decompression: a prospective study of 1003 patients. Neurosurgery. 2011;69:119–27.Google Scholar
11Ford, PJ, Boulis, NM, Montgomery, EB, Rezai, AR.A patient revoking consent during awake craniotomy: An ethical challenge. Neuromodulation. 2007;10:329–32.Google Scholar
12Ford, PJ, Kubu, CS.Stimulating debate: ethics in a multidisciplinary functional neurosurgery committee. J Med Ethics. 2006;32:106–9.CrossRefGoogle Scholar
13Bernstein, M.Ethical guideposts to clinical trials in oncology. Curr Oncol. 2006;13:55–60.Google Scholar
14Gupta, DK, Chandra, PS, Ojha, BK, Sharma, BS, Mahapatra, AK, Mehta, VS.Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex-a prospective randomised study. Clin Neurol Neurosurg. 2007; 109:335–43.Google Scholar
15Khu, KJ, Doglietto, F, Radovanovic, I, et al.Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. J Neurosurg. 2010;112:1056–60.Google Scholar
16Danks, RA, Rogers, M, Aglio, LS, Gugino, LD, Black, PM.Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation. Neurosurgery. 1998;42:28–34.CrossRefGoogle ScholarPubMed
17Conte, V, Baratta, P, Tomaselli, P, Songa, V, Magni, L, Stocchetti, N.Awake neurosurgery: an update. Minerva Anestesiol. 2008;74: 289–92.Google Scholar
18Berger, MS.The impact of technical adjuncts in the surgical management of cerebral hemispheric low-grade gliomas of childhood. J Neurooncol. 1996;28:129–55.Google Scholar
19Bernstein, M, Khu, KJ.Is there too much variability in technical neurosurgery decision-making? Virtual Tumour Board of a challenging case. Acta Neurochir (Wien). 2009;151:411–12.Google Scholar
20Irwin, ZN, Hilibrand, A, Gustavel, M, et al.Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine. Spine (Phila Pa 1976). 2005;30:2208–13.Google Scholar
21Nassr, A, Lee, JY, Dvorak, MF, et al.Variations in surgical treatment of cervical facet dislocations. Spine (Phila Pa 1976). 2008;33: E188–93.Google Scholar
22Bernstein, M.Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients. Can J Neurol Sci. 2001;28: 120–4.Google Scholar
23Bernstein, M.Outpatient brain tumour surgery. A new paradigm in healthcare delivery. Oncol Exch. 2004;3:20–3.Google Scholar
24Bhattacharrya, AK, Bernstein, M.Outpatient neurosurgery: state of the art, feasibility, and relevance. Adv Clin Neurosci. 2003;13: 15–26.Google Scholar
25Bernstein, M.Conflict of interest: it is ethical for an investigator to also be the primary care-giver in a clinical trial. J Neurooncol. 2003;63:107–8.Google Scholar
26Bernstein, M, Bampoe, J.Surgical innovation or surgical evolution: an ethical and practical guide to handling novel neurosurgical procedures. J Neurosurg. 2004;100:2–7.Google Scholar
27Herrick, IA, Craen, RA, Gelb, AW, et al.Propofol sedation during awake craniotomy for seizures: patient-controlled administration versus neurolept analgesia. Anesth Analg. 1997;84:1285–91.Google Scholar
28Koller, W, Pahwa, R, Busenbark, K, et al.High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol. 1997;42:292–9.CrossRefGoogle ScholarPubMed
29Baker, GR, Norton, PG, Flintoft, V, et al.The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170:1678–86.CrossRefGoogle Scholar
30Stone, S, Bernstein, M.Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. Neurosurgery. 2007;60:1075–80.Google Scholar
31Knifed, E, July, J, Bernstein, M.Neurosurgery patients’ feelings about the role of residents in their care: a qualitative case study. J Neurosurg. 2008;108:287–91.Google Scholar
32Zener, R, Bernstein, M.Gender, patient comfort, and the neurosurgical operating room. Can J Neurol Sci. 2011;38:65–71.Google Scholar
33Menges, RJ.Openness and honesty versus coercion and deception in psychological research. Am Psychol. 1973;28:1030–4.CrossRefGoogle ScholarPubMed
34Miller, FG, Rosenstein, DL, DeRenzo, EG.Professional integrity in clinical research. JAMA. 1998;280:1449–54.Google Scholar