Direct electrical stimulation as an input gate into brain functional networks: principles, advantages and limitations

Area of Science:

• Neuroscience
• Neurosurgery
• Brain Mapping

Background:

• Direct electrical stimulation (DES) is a well-established technique in neuroscience and neurosurgery.
• However, a comprehensive re-evaluation of its benefits and drawbacks in understanding brain function is overdue.

Purpose of the Study:

• To critically assess the insights gained from DES regarding cerebral function.
• To re-evaluate the advantages and limitations of DES in modern neuroscientific research.

Main Methods:

• Systematic review of existing literature on direct electrical stimulation (DES).
• Analysis of DES capabilities in identifying eloquent brain structures and networks.
• Evaluation of DES limitations, including specificity and compensatory plasticity.

Main Results:

• DES demonstrates high sensitivity in detecting critical cortical and axonal structures.
• DES offers unique insights into brain connectivity, revealing functional networks rather than isolated sites.
• DES exhibits suboptimal specificity, potentially leading to misinterpretations of functional importance due to network spread or plasticity.

Conclusions:

• Direct electrical stimulation (DES) remains the gold standard for intraoperative brain mapping.
• Integrating DES with perioperative neurofunctional imaging and biomathematical modeling is essential.
• This integration allows for precise differentiation between indispensable and compensated neural networks.