AGR-4: Safety Screening for Awake Procedures: The Role of Neuropsychologists

Abstract Objective: Pre-surgical neuropsychological assessments are not only key for prognosticating post-operative outcomes, but also evaluating a patient’s candidacy to safely engage in an awake procedure. Comprehensive clinical interviewing discussing a patient’s history of claustrophobia, pain tolerance, and history of medical trauma, coupled with objective measures of these constructs should be regularly integrated into pre-operative evaluations. Method/Data Selection: Patient A (64 y.o.) was a candidate for Deep Brain Stimulation implantation and was a prisoner-of-war, resulting in claustrophobia and PTSD. Patient B (64. y.o.) required an awake craniotomy with language mapping and disclosed physical aggression during prior medical procedures, resulting in bodily harm to healthcare workers and physical damage to equipment. The Claustrophobia Questionnaire (CLQ) and Aggressive Behavior Risk Assessment Tool (ABRAT) were administered. Results/Data Synthesis: Patient A’s CLQ data yielded elevations on restriction and suffocation subscales. The neurosurgical team then partnered with anesthesiology to optimally position the patient. Although highly fluent in English, an interpreter in the patient’s native language provided additional intraoperative support. Beyond high ratings on the CLS, Patient B’s ABRAT total score indicated an elevated risk of violence. Conclusions: Though neither patient disclosed concerns during pre-operative consultations with neurosurgeons, neuropsychological assessment was a valuable tool to identify two patients at increased risk of adverse intra-operative events. Such knowledge allows for proactive implementation of supportive strategies/modifications in the OR (Patient A) or deferral of the procedure (Patient B) aimed at preserving patient and staff safety.