Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls.

Simple Summary: Awake craniotomy (AC) is a neurosurgical technique that allows safe and efficient resection of brain tumors in eloquent areas. It can be completed using two anesthetic strategies: monitored anesthesia care (MAC), which relies on pharmacological sedation and analgesia, or hypnosis-assisted awake craniotomy (HAAC), during which hypnotic suggestions could reduce the need for hypnotics and opioids. In this study, we retrospectively compared the characteristics and outcomes of patients undergoing AC with either one of those anesthetic techniques. A total of 22 patients were analyzed: 14 underwent HAAC and 8 underwent AC under MAC. Compared to patients in the MAC group, those in the HAAC group received a significantly smaller quantity of hypnotics and analgesics. Although patients in the HAAC group experienced more pain, they reported lower stress levels and higher satisfaction scores. These results suggest that HAAC safely reduces the need for pharmacological agents during surgery while providing significant psychological benefits. However, further research is needed to confirm and expand this preliminary work. Background: Awake craniotomy (AC) is recommended for the resection of tumors in eloquent areas. It is traditionally performed under monitored anesthesia care (MAC), which relies on hypnotics and opioids. Hypnosis-assisted AC (HAAC) is an emerging technique that aims to provide psychological support while reducing the need for pharmacological sedation and analgesia. We aimed to compare the characteristics and outcomes of patients who underwent AC under HAAC or MAC. Methods: We retrospectively analyzed the clinical, anesthetic, surgical, and neuropsychological data of patients who underwent awake surgical resection of eloquent brain tumors under HAAC or MAC. We used Mann–Whitney U tests, Wilcoxon signed-rank tests, and repeated-measures analyses of variance to identify statistically significant differences at the 0.05 level. Results: A total of 22 patients were analyzed, 14 in the HAAC group and 8 in the MAC group. Demographic, radiological, and surgical characteristics as well as postoperative outcomes were similar. Patients in the HAAC group received less remifentanil (p = 0.047) and propofol (p = 0.002), but more dexmedetomidine (p = 0.025). None of them received ketamine as a rescue analgesic. Although patients in the HAAC group experienced higher levels of perioperative pain (p < 0.05), they reported decreasing stress levels (p = 0.04) and greater levels of satisfaction (p = 0.02). Conclusion: HAAC is a safe alternative to MAC as it reduces perioperative stress and increases overall satisfaction. Further research is necessary to assess whether hypnosis is clinically beneficial. [ABSTRACT FROM AUTHOR]