Objective:

To outline the awake surgery technique using direct electrical stimulation (DES) and real-time cognitive monitoring, emphasizing its significance for optimal tumor resection outcomes.

Key Findings:

• Awake surgery with DES improves onco-functional outcomes with less than 2% permanent deficits.
• High cognitive preservation and approximately 94% return-to-work rates are reported, with references to source material.
• Survival rates can exceed 20 years with this technique.

Interpretation:

The integration of real-time cognitive monitoring with DES allows for individualized tumor resection strategies that prioritize patient-specific functional needs, developed through tailored cognitive tasks.

Limitations:

• Requires meticulous adherence to technical and practical principles.
• Patient cooperation is essential, which may not be achievable in cases of severe anxiety or cognitive impairment.

Conclusion:

Awake surgery with DES represents a significant advancement in neurosurgery, enabling tailored approaches to tumor resection that enhance patient outcomes and set a precedent for future practices.