Virtual Reality during Brain Mapping for Awake-Patient Brain Tumor Surgery: Proposed Tasks and Domains to Test.
Virtual Reality (VR) use in healthcare has increased over the past few decades, with its utility expanding from a teaching tool to a highly reliable neuro-technology adjunct in multiple fields including neurosurgery. Generally, brain tumor surgery with the patient awake has only been performed for mapping of language and motor areas. With the rise of VR and advancing surgical techniques, neurosurgical teams are developing an increased understanding of patients’ anatomo-functional connectivity. Consequently, more specific cognitive tasks are being required for the mapping and preservation of deeper layers of cognition. This presents an opportunity for the integration of immersive technologies to generate an objective and more in-depth assessment of oncological patients. The introduction of VR in awake brain tumor surgery has proven to be feasible, especially in pre-surgical anxiety. Together with systematic desensitization techniques, it has proven to be effective in helping with social cognition mapping. These techniques work by engaging an awake patient in social recognition tasks with a neuropsychologist´s avatar during surgery. The authors advocate for the use of a VR protocol as a functional tool in awake-patient brain tumor surgery by using it as a complement during cognitive screening, language mapping, anxiety measuring, and post-surgical cognitive rehabilitation programs. This review serves to present the current literature discussing the integration of VR into the mapping portion of awake brain tumor surgery and describes a proposed protocol to improve upon existing paradigms. In doing so, the authors propose various intraoperative VR tasks and the respective domains that can be tested.Copyright © 2021. Published by Elsevier Inc.