Application of navigation-assisted direct electrical stimulation in protection of neurologic function in tumor surgery located at functional areas

Abstract

Objective To explore the application of navigation-assisted direct electrical stimulation (DES) in the protection of neurologic function in surgery of tumors located at functional areas. Methods Ten patients with brain tumors at the functional areas, admitted to our hospital from December 2012 to October 2014, were chosen; they were performed navigation-assisted DES using bipolar stimulating electrodes connected neuronavigation system. Preoperative motor function evaluated by Fugl-Meyer scale and verbal function evaluated by Western Aphasia Battery were underway. The motor and language functions and tumor resection rate were analyzed and compared before and after surgery. Results Total resection was achieved in 7 patients and subtotal resection in 3 patients. Accurate identification of related functional areas was successful in 8 patients (80%) in the operation, including 4 of the cortical motor function area, 6 of subcortical motor tracts, and one of subcortical language conduction bundle. After the operation, one patient experienced transient motor dysfunction and recovered after 3 months, and two experienced mild decline in motor function (20%), but there was no dysfunction of disabling movement. In four patients with language dysfunction, one experienced language function decline (10%) and 3 got improvement (30%). The postoperative neurologic protection was satisfied. Conclusion Navigation-assisted DES can significantly reduce the occurrence rate of postoperative neurological dysfunction, improve the life quality of patients with tumors located at the functional areas. Key words: Neuronavigatin; Diffusion tensor imaging; Intra-operative direct electrical stimulation; Functional area; Neurologic function