• Gennadiy A Katsevman, Walter Greenleaf, Ricardo García-García, Maria Victoria Perea, Valentina Ladera, Jonathan H Sherman, and Gabriel Rodríguez.
• Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
• World Neurosurg. 2021 Aug 1; 152: e462e466e462-e466.

BackgroundVirtual reality (VR) use in health care 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.MethodsAn extensive literature review was conducted with the inclusion criteria of manuscripts that described the use of VR during awake neurosurgery mapping.ResultsWe identified 3 recent articles that met our inclusion criteria, yet none of them addressed the specific use of VR for cognition mapping. Consequently, a cognitive task phase was performed to search and craft the tasks and domains that better filled the spotted niche of this need inside the operating room. A proposed protocol was developed with 5 potential uses of VR for brain mapping during awake neurosurgery, each of them with a specific proposed example of use.ConclusionsThe authors advocate for the use of a VR protocol as a feasible functional tool in awake-patient brain tumor surgery by using it as a complement during cognitive screening in addition to language testing.Copyright © 2021 Elsevier Inc. All rights reserved.

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