Hypnosis appears to be able to help reduce the psychological trauma associated with brain surgery performed while the patient is awake. A "hypnosedation" technique offers neurosurgeons an alternative for patients undergoing awake surgery for gliomas, according to a new study.
A research team in Tours, France, evaluated a hypnosis technique in 37 patients who were undergoing "awake craniotomy" for a type of tumor called a glioma. In awake craniotomy, the patient is anesthetized but is kept conscious so that he or she can communicate during the surgery. This communication helps the surgeon navigate to the tumor without damaging the areas of the brain involved in language or movement. Usually in this type of surgery, a patient is put to sleep, and then awakened for communication, and then put to sleep again, which can be challenging in patients with high-grade gliomas.
Preparation for the use of hypnosis in the procedure began a few weeks before surgery. An anesthesiologist who was also a hypnotist met with each patient to carry out a short hypnosis session and teach the patient how to create an imaginary place where they can feel safe and effective. During the surgery, the patients were placed in a hypnotic trance. The hypnotic experience was progressively enhanced during the first steps of surgery, and included specific instructions and imagery for each potentially unpleasant or painful step of the surgery.
The 37 patients underwent a total of 43 surgeries with hypnosedation, including repeat surgeries for recurrent gliomas. Hypnosis failed in six patients, who underwent standard anesthesia. Another two patients decided not to undergo hypnosis.
When it was successful, hypnosis was a reliable and reproducible method for awake craniotomy. Patients filled out questionnaires and their answers showed little or no negative psychological impact. The success of hypnosis seemed to be most strongly related to the patients' motivation and determination.
Hypnosedation seemed to reduce the impact of unpleasant events during surgery. Some patients reported high stress levels, but this did not appear to affect their experience of hypnosis. Pain seemed to decrease as the level of hypnosis deepened. Only two patients said they would not choose hypnosedation if they had to undergo a second awake craniotomy.
While these results are encouraging, the researchers noted that they do not show that hypnosedation is superior to standard anesthesia. They also noted that it requires intense involvement and long training for the surgical team and the patient.
The online version of the article, published in the journal Neurosurgery can be read here and includes a video of the hypnosedation procedure.