We believe sound research goes hand-in-hand with good clinical work, which is why our awake brain surgery team try to publish when we can. While we are an academic health institution, most clinicians do not have official time set aside for research. It really is the passion for the subject matter and drive to do better for our patients that keep us going, as we brainstorm idea after idea to test out. Oftentimes, our experience is that our research findings feed directly back into our clinical methods, leading to improved care and outcomes for our patients.
Given the theme of this platform, which is about supporting the growth of the neuropsychology field in Asia, I thought it would be nice to share our latest publication. It is a simple qualitative/quantitative study but nicely done. Spearheaded by one of our neurosurgery residents pursuing a PhD, it is about the acceptance of awake craniotomy* to resect brain tumours in a predominantly Asian population.
A structured questionnaire was administered to our patients who have undergone an awake brain surgery to explore their experience of the pre-, intra-, and post-operative stages. Our residents managed to interview a total of 18** patients. While we develop close working relationships with our patients because of the very involved nature of awake surgeries, the feedback was better than I had expected. Just focusing on the neuropsychology-related responses, 95% felt well-counselled by the neuropsychologist prior to the operation, 90-100% found intra-operative tasks to be well understood, and 100% were satisfied with their post-operative care. Most significantly for me, 80% said they would do another awake craniotomy if clinically indicated (i.e. if there is a clinical need, such as when there is a tumour recurrence). The conclusion we arrived at was that awake craniotomy for brain tumours is well-accepted in our Asian population.
Of course there are limitations to the study, for example there was likely a self-selection bias in that patients who gave feedback were the keener ones. But I must say that the findings correspond to my clinical experience with this group of patients and their loved ones, who despite the shock of the brain tumour diagnosis and initial misgivings about the nature of the surgery, end up displaying so much perseverance and grit throughout the whole process. Nevertheless, there definitely exists a smaller proportion of patients who shared with us personally that they did not have a good experience, but it was not solely because the surgery was carried out under awake conditions (i.e. the subpar experience would have been similar even if the surgery were done under general anaesthesia / asleep).
I think research allows us to reflect on a deeper level about how we perform our clinical work, and we need to continue engaging in research if we wish to strive for clinical excellence.
If you’re interested in reading the full paper, drop me an email!
*You may be wondering what awake craniotomy means. Johns Hopkins describes “craniotomy” as “the surgical removal of part of the bone from the skull to expose the brain”. In short, awake craniotomy is brain surgery performed when the patient is under awake conditions. But rest assured – patients are sedated (i.e. under anaesthesia) at the beginning of the surgery when the skull is being removed and only awakened when the brain is exposed. The brain doesn’t feel pain as nociceptors (sensory neurons that send pain signals to the brain) don’t develop in the brain. If you are interested in a short layperson description of the process of how we feel pain, see https://neuroscience.stanford.edu/news/pain-brain. It touches on pain in the brain too!
**One of the difficulties in awake brain surgery research in general, but particularly for younger teams like ours, is that there aren’t huge numbers of patients to begin with. Hence, we bide our time and collect data longitudinally over years, so that meaningful interpretations can be done with more data points.