Background Language mapping during awake brain surgery is currently a standard procedure. However, mapping is rarely performed for other cognitive functions that are important for social interaction, such as visuospatial cognition and nonverbal language, including facial expressions and eye gaze. The main reason for this omission is the lack of tasks that are fully compatible with the restrictive environment of an operating room and awake brain surgery procedures. Objective This study aims to evaluate the feasibility and safety of a virtual reality headset equipped with an eye-tracking device that is able to promote an immersive visuospatial and social virtual reality (VR) experience for patients undergoing awake craniotomy. Methods We recruited 15 patients with brain tumors near language and/or motor areas. Language mapping was performed with a naming task, DO 80, presented on a computer tablet and then in 2D and 3D via the VRH. Patients were also immersed in a visuospatial and social VR experience. Results None of the patients experienced VR sickness, whereas 2 patients had an intraoperative focal seizure without consequence; there was no reason to attribute these seizures to virtual reality headset use. The patients were able to perform the VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients’ attention and exploration of the visual field of the virtual reality headset directly. Conclusions We found that it is possible and safe to immerse the patient in an interactive virtual environment during awake brain surgery, paving the way for new VR-based brain mapping procedures. Trial Registration ClinicalTrials.gov NCT03010943; https://clinicaltrials.gov/ct2/show/NCT03010943.

BACKGROUND Preserving major cognitive functions, such as visuo-spatial and social cognition in the surgical management of brain tumors could be decisive for the postoperative quality of life. Using virtual reality during awake brain surgery appears to be interesting for preserving complex cognitive functions. Developing neuropsychological tasks appropriate for use during awake brain surgery using virtual reality technology is challenging. OBJECTIVE In this paper, we describe our preliminary experience of extending progressively complex cognitive paradigms via dynamic VR environments during 68 peri-operative brain mapping. METHODS This is a single center, retrospective longitudinal study, concerning two cohorts. RESULTS A total of 65 patients (30 women, mean age 49.7, range 23-75) operated with VR-assisted Brain mapping were included. At least one VR task (VR-DO 80, VR Estermann or VR-TANGO task) during DES were done for all the patients. The mean duration of surgery was 4 h 30 min, the mean duration of the awake phase was 2 h 15 min. The mean intensity used for DES was 3 mA (Intensity from 0,5 to 8 mA). Mean total duration of VRH use per patient at 16 min (from 10 to 37 min). VR task allowed to preserve language, visual field, visuospatial and social cognition in our serie. CONCLUSIONS We show through illustrative cases how VR opens new possibilities for the mapping of complex cognitive functions within the operating theater. CLINICALTRIAL ClinicalTrials.gov NCT03010943Virtual reality; awake neurosurgery; visual field; social cognition; visuospatial cognition; unilateral spatial neglect. INTERNATIONAL REGISTERED REPORT RR2-10.2196/10332.

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Background: Awake craniotomy (AC) with brain mapping for language and motor functions is often performed for tumors within or adjacent to eloquent brain regions. However, other important functions, such as vision and visuospatial and social cognition, are less frequently mapped, at least partly due to the difficulty of defining tasks suitable for the constrained AC environment. Objective: The aim of this retrospective study was to demonstrate, through illustrative cases, how a virtual reality headset (VRH) equipped with eye tracking can open up new possibilities for the mapping of language, the visual field and complex cognitive functions in the operating room. Methods: Virtual reality (VR) tasks performed during 69 ACs were evaluated retrospectively. Three types of VR tasks were used: VR-DO80 for language evaluation, VR-Esterman for visual field assessment and VR-TANGO for the evaluation of visuospatial and social functions. Results: Surgery was performed on the right hemisphere for 29 of the 69 ACs performed (42.0%). One AC (1.5%) was performed with all three VR tasks, 14 ACs (20.3%) were performed with two VR tasks and 54 ACs (78.3%) were performed with one VR task. The median duration of VRH use per patient was 15.5 min. None of the patients had “VR sickness”. Only transitory focal seizures of no consequence and unrelated to VRH use were observed during AC. Patients were able to perform all VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients’ attention and exploration of the visual field of the VRH directly. Conclusions: This preliminary experiment shows that VR approaches can provide neurosurgeons with a way of investigating various functions, including social cognition during AC. Given the rapid advances in VR technology and the unbelievable sense of immersion provided by the most recent devices, there is a need for ongoing reflection and discussions of the ethical and methodological considerations associated with the use of these advanced technologies in AC and brain mapping procedures.

BACKGROUND Language mapping during awake brain surgery is currently a standard procedure. However, mapping is rarely performed for other cognitive functions that are important for social interaction, such as visuospatial cognition and nonverbal language, including facial expressions and eye gaze. The main reason for this omission is the lack of tasks that are fully compatible with the restrictive environment of an operating room and awake brain surgery procedures. OBJECTIVE This study aims to evaluate the feasibility and safety of a virtual reality headset equipped with an eye-tracking device that is able to promote an immersive visuospatial and social virtual reality (VR) experience for patients undergoing awake craniotomy. METHODS We recruited 15 patients with brain tumors near language and/or motor areas. Language mapping was performed with a naming task, DO 80, presented on a computer tablet and then in 2D and 3D via the VRH. Patients were also immersed in a visuospatial and social VR experience. RESULTS None of the patients experienced VR sickness, whereas 2 patients had an intraoperative focal seizure without consequence; there was no reason to attribute these seizures to virtual reality headset use. The patients were able to perform the VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients’ attention and exploration of the visual field of the virtual reality headset directly. CONCLUSIONS We found that it is possible and safe to immerse the patient in an interactive virtual environment during awake brain surgery, paving the way for new VR-based brain mapping procedures. CLINICALTRIAL ClinicalTrials.gov NCT03010943; https://clinicaltrials.gov/ct2/show/NCT03010943.