Direct electrical stimulation and awake anaesthesia for eloquent brain regions surgery involved in eloquent areas

Objective To explore the application of the awake anesthesia and intra-operative cortico-subcortical electro-stimulation in the surgery for patients with lesions in eloquent areas. Methods Retrospective analysis of 10 patients with lesions in eloquent area, admitted to our hospital from May 2011 to December 2013, was performed. Neuroimaging was used to assess the location of the lesions before surgery, neuron-navigation was used in the craniotomy, awake anesthesia and intra-operative cortico-subcortical electro-stimulation in the surgery of lesions in eloquent areas was performed; and then, total excision of the lesions was adopted. Results Specific motor response was monitored in all the 10 patients accepted cortico-subcortical electro-stimulation, which was matched with that from anterior central gyrus; 5 of them also performed electrophotoluminescence in the language area could be detected with positive reactions. In all 10 patients, total resection was achieved in 8 and subtotal excision in 2. Two patients had transient language dysfunction after operation and got improvement within one week, and recovered to the normal state in three weeks. Myodynamia transitorily decreased in 3 patients after operation and started recovery in one week and achieved the normal state in three month. Perpetual aphasis was noted in all the patients. Conclusion Awake anesthesia and intraoperative direct electrical stimulation were helpful to distinguish lesions from eloquent area, which is a reliable, precise, and safe eloquent area location method; maximum resection of the lesions and minimal damage to the eloquent area can be achieved and the life quality of patients can be improved. Key words: Awake anesthesia; Electrical stimulation; Eloquent area; Microsurgery