An Anaesthetic Alternative: Hypnotised in Neurosurgery

Being awake during open brain surgery is an ordeal that is inconceivable to most, but is a stark reality for many sufferers with epilepsy and brain tumours. Early research provides compelling evidence that hypnosis-aided awake surgery leads to reduced intraoperative pain and complications, compared to standard awake surgery. In cases where general anaesthesia cannot be used, this novel method could lessen patient anxiety and pain during intracranial surgery.

When brain tumours or epileptic regions are located near, or within functionally significant areas (e.g. the motor or visual cortex), patients must be awake during the operation to minimise damage to these parts. During the surgery, the brain is mapped with the aid of MRIs, electrical stimulation and real-time feedback from patients. Thus, the surgeon can avoid damaging the patient’s functional areas whilst removing the problematic brain region.

In a 2018 study, 52% of subjects who underwent awake brain surgery reported slight or severe pain during the operation. The average duration of surgery was 223 minutes. With no general anaesthesia, a non-pharmacological alternative to increase patient well-being had to be explored.

Italian neurosurgeon Dr. Alessandro Frati believes that hypnosis is the answer. His innovative study was recently published in World Neurosurgery, in which 6 patients had their brain tumours removed using hypnosis-aided surgery (HAS). Local anaesthesia was used to access the brain, then patients were hypnotised during the operation which put them in a dissociated “safe place.”

Frati’s results found that HAS produced significantly lower pain and discomfort during the surgery. In his sample, 0% of his subjects reported intraoperative pain. Additionally, the overall incidence of complications both during and after surgery were significantly reduced. He states that HAS is useful to “preserve the patient’s ability to perform tasks” and to “cause amnesia of the entire surgical procedure at the same time”. The method suggests a simple and effective alternative to standard awake surgery.

“Hypnosis is clearly a very interesting and helpful tool to provide more comfort for the patient, reducing pain and anxiety during awake neurological monitoring”, says Gilda Pardey Bracho from France’s Department of Anaesthesia and Critical Care. For the last two years, Bracho has been training in medical hypnosis to use HAS protocol in neurosurgery. She commends Frati’s study and adds that hypnosedation “optimises the comfort and well-being of the patient during surgery”.

However, it is important to note that not everyone is susceptible to hypnosis. “Of course, such a method cannot be used with all patients”, says Dr. Rupert Reichart, medical hypnotist and neurosurgeon of the University of Vienna. He suggests that there are still limitations to the use of HAS protocol. “But patients who do not tolerate anaesthesia, for example, can benefit from it – if they are hypnotic”, says Reichart.

A 2018 study showed that the effectiveness of hypnotism varied within the population. With 60-79% of people being moderately susceptible, and 5-10% being highly susceptible. This suggests that HAS protocol has the potential to be widely used as a safer alternative to awake brain surgery in patients with brain tumours and epilepsy.

Although a novel method, the results could lead to improvements in the physical and mental health of awake brain surgery patients. “Hypnosis in this kind of surgery is not well documented but represents an innovative technique that aims to improve neurosurgical management”, says Bracho. It is early days, but the intuitiveness and potential of hypnosis-aided surgery is obvious. Would you want to be awake during surgery?