Surgical informed consent in neurosurgery
tumor, Tumor, meningiomas, cerebral aneurysm, extra-axial tumors
TUMOR, TUMOR, BRAIN TUMOR, MENINGIOMAS, CEREBRAL ANEURYSM, COMPLICATIONS
The field of neurosurgery and the specific anatomy of the brain can present a great challenge even for experts. The surgical procedures in the brain are particularly complex, and it is very difficult for patients to understand them even in lay terms [The subjective analysis showed that the patients already indicated a high level of understanding for the upcoming procedure and possible complications after the conventional patient consent conversation. However, these subjective statements could not be confirmed objectively since the patients did not perform well on the anatomical and procedural questions. In our study, adding stereoscopic display of imaging data did not improve patient competency. Likewise, Agarwal et al. did not observe any improvement in patient knowledge in another neurosurgical study, where patients with cerebral aneurysm in the intervention group received a presentation with text and visual graphics [With regard to patient and tumor characteristics, we did not find significant differences between the two groups. Tumor locations differed slightly but did not reach significance. Strikingly, meningiomas as extra-axial tumors were slightly more frequent in group A (40%), but since the overall proportion of benign and malignant entities was similar in both groups, we consider that the two groups were well comparable. Importantly, in our study, the only difference between the two consents was the visualization technique of the personalized MRI, while the content and the doctor in charge remained the same for each patient. As non-medical laypersons have difficulty understanding two-dimensional (2D) cross-sectional images of intracranial topography, patients seem to connect more easily to the somewhat more lifelike stereoscopic visualization of their own neuroimaging data. One could argue that surgeons may use stereoscopic 3D for better anatomical preparation while patients have other, more general primary concerns such as the confirmed existence, location, and size of a brain tumor as the individual interviews have shown. Interestingly, the patients preferred the sagittal view while physicians tended to prefer the axial view. Perhaps the participants were able to better assess the position and size relationships in the profile of the face presented in the sagittal view. This should be considered for future investigations.New possibilities of video recording techniques also enable other innovative ways of informing patients. For instance, it is now possible to generate 360-degree surgical videos that could be integrated in the surgical informed consent process. These videos could also be annotated if needed as Johnson et al. recently did to educate patients for external beam radiation therapy [