The role of hypnosis (no sedative drug administered) and hypnosedative procedures (hypnosis
with the adjunct of a sedative drug) during surgical procedures has been largely discussed
during the past 10 years, and those techniques are now widely practiced in the surgical
field, for example during thyroidectomies. In neurosurgery specifically, the successful use
of hypnosedation during awake neurosurgical procedures has been recently reported, with a
positive feedback from the patients, together with good results regarding extent of
resection, in the case of brain lesions located in eloquent areas.
Since 1990, many research groups identified the existence of hypnosis-related phenomena and
their influence on the pain signal perception. These authors show that there is a modulation
of the anterior cingulate area activity together with modified interconnectivity with other
critical regions involved in nociception. In this context, the potential of hypnosis in pain
modulation and, more extensively, patient management in surgical anesthetics was established.
In various neurosurgical procedures, the use of a stereotactic frame is required; by using
coordinates (x, y and z), which are computed and reported on the frame before the
intervention, it is possible to set a precise target (dependent on the type of surgery) to be
reached by the surgeon. For instance, during a Deep Brain Stimulation (DBS) performed in a
patient suffering from Parkinson's disease (PD), the electrodes are introduced into the
brain, deep down to the sub-thalamic nuclei (STN), which are situated in a very little area
located in the upper brainstem. The mounting of the stereotactic frame on the patient's head
is performed under local anesthesia (LA), as the patient is awake during the mounting
procedure and later on during the surgical intervention. This mounting is done by screwing
the device directly into the patient's skull, through the skin. This moment is reported as
"painful" to "extremely painful" by patients, and most of them confess to keep a very
unpleasant memory of the event, even several years after the procedure and despite the fact
that the surgery had a positive effect on their functional outcome.
As exposed above, there is still room for improvement in the management of pain and comfort
of patients undergoing functional procedures in neurosurgery, especially during the placement
of the stereotactic frame. To our opinion, hypnosis could represent a serious therapy against
pain and anxiety generated by the frame fixation, especially those whom facial expressions
and feelings might be altered by their pathology (i.e. Parkinson's disease). In fact, this
technique has already been abundantly reported as an important adjuvant to the management of
pain and comfort during surgeries such as thyroidectomies) and resection of brain tumors.
The main objective of this study is to determine whether hypnosis is effective in decreasing
the pain perceived by the patient during the placement of the stereotactic frame on the
patient's head.
The secondary aims of this study are: 1) to measure the stress perceived during the procedure
by submitting the patient to validated scores and 2) to evaluate the incidence of
Post-traumatic Stress Disorder (PTSD), according to the Diagnostic and Statistical Manual of
Mental Disorders IV (DSM-IV) criteria.