Application of direct electrical stimulation in resection of neuroepithelial tumors located in eloquent areas

Objective To review our experience on the application of direct electrical stimulation in resection of neuroepithelial tumors located in supratentorial eloquent areas.Methods A total of 44 patients with supratentorial neuroepithelial tumors were operated under awake anesthesia with intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The maximal resection of tumors and minimal damage of the eloquent areas were the surgical goal of all patients.Results A total of 39 patients were detected on the motor areas by intraoperative direct electrical stimulation and 14 patients on language related cortex. Total resection was achieved in 28 cases, subtotal in 12 cases and partial in 4 cases. The median follow-up was 23.5 months. A total of 35 patients survived without progression and 6 patients died. Among the 6 dead patients, 5 patients were diagnosed as glioblastomas. A total of 17 patients had no postoperative deficits, while 15 patients with transitory postoperative paralysis, 11 patients with transitory postoperative aphasia and one patient with permanent paralysis. No patient complained of pain in operation. Conclusion Intraoperative direct electrical stimulation is a reliable, precise and safe method for functional mapping of the eloquent areas. This technique allows a minimal postoperative neurological deficit and an improvement in the quality of resection.