New research has found that hypnosis can help to reduce the psychological trauma associated with awake craniotomy for brain cancers.
Initial evaluation of the hypnosedation technique shows a high rate of successful hypnosis in patients undergoing awake craniotomy for brain cancer (glioma), according to Dr. Ilyess Zemmoura of Centre Hospitalier Universitaire de Tours in France.
The researchers add they believe that hypnosedation might be especially valuable in patients with more advanced brain cancers.
Zemmoura and his colleagues evaluated their hypnosis technique in 37 patients undergoing awake craniotomy, mainly for low-grade gliomas, between 2011 and 2015.
In awake craniotomy, the patient is sedated but conscious so he or she can communicate during the surgery. This helps the surgeon navigate safely to the tumor without damaging the “eloquent cortex” — critical areas of the brain involved in language or movement.
According to the researchers, preparation for hypnosis begins a few weeks before surgery. The anesthesiologist/hypnotist meets with the patient to carry out a short hypnosis session and teach the patient how to create a “safe place” — an imaginary place where they can feel safe and effective.
In the operating room, patients are placed in a hypnotic trance. For example, they are instructed to “let go” and to “separate the mind and body.”
The hypnotic experience is progressively enhanced during the first steps of surgery, including specific instructions and imagery for each potentially unpleasant or painful step of the surgery, the researchers relate.
The 37 patients underwent a total of 43 surgeries with hypnosedation. Hypnosis failed in six patients, who underwent standard “asleep-awake-asleep” anesthesia. Another two patients decided not to undergo hypnosis.
When successful, hypnosis was a reliable and reproducible method for awake surgery, with questionnaire assessments showing little or no negative psychological impact, the researchers reported.
Rather than any measure of individual “hypnotizability,” the success of hypnosis seemed to be most strongly related to the patients’ motivation and determination, they found.
Hypnosedation also seemed to reduce the impact of unpleasant events during surgery. Some patients reported high stress levels, but this did not appear to affect their subjective experience of hypnosis, according to the researchers. The one patient who showed signs of post-traumatic stress disorder after surgery had a particularly good experience with hypnosis, they note.
For patients, the most unpleasant parts of surgery were steps involving noise and vibration. Pain seemed to decrease as the level of hypnosis deepened. Only two patients said they would not choose to undergo hypnosedation if they had to undergo a second awake craniotomy, the researchers said.
An important advantage of hypnosedation is that it allows the patient to remain awake throughout surgery. This avoids the need to awaken the patient in the middle of standard “asleep-awake-asleep” anesthesia, which can be especially challenging in patients with high-grade gliomas, the scientists said. They noted their experience included successful hypnosedation in two patients with high-grade gliomas.
While the initial evaluation is encouraging, Zemmoura and the research team note that it provides no evidence that hypnosedation is superior to standard anesthesia.
They also emphasize the considerable investment of time and commitment needed to prepare for and carry out the hypnosis technique.
“It requires intense involvement and long training of the whole team, including the patient,” they noted in the study, which was published in Neurosurgery, official journal of the Congress of Neurological Surgeons, published by Wolters Kluwer.