• Edouard Mazerand, Marc Le Renard, Sophie Hue, Jean-Michel Lemée, Evelyne Klinger, and Philippe Menei.
• Department of Neurosurgery, CHU Angers, Angers, France. Electronic address: emazerand@gmail.com.
• World Neurosurg. 2017 Jan 1; 97: 424-430.

BackgroundBrain mapping during awake craniotomy is a well-known technique to preserve neurological functions, especially the language. It is still challenging to map the optic radiations due to the difficulty to test the visual field intraoperatively. To assess the visual field during awake craniotomy, we developed the Functions' Explorer based on a virtual reality headset (FEX-VRH).MethodsThe impaired visual field of 10 patients was tested with automated perimetry (the gold standard examination) and the FEX-VRH. The proof-of-concept test was done during the surgery performed on a patient who was blind in his right eye and presenting with a left parietotemporal glioblastoma. The FEX-VRH was used intraoperatively, simultaneously with direct subcortical electrostimulation, allowing identification and preservation of the optic radiations.ResultsThe FEX-VRH detected 9 of the 10 visual field defects found by automated perimetry. The patient who underwent an awake craniotomy with intraoperative mapping of the optic tract using the FEX-VRH had no permanent postoperative visual field defect.ConclusionIntraoperative visual field assessment with the FEX-VRH during direct subcortical electrostimulation is a promising approach to mapping the optical radiations and preventing a permanent visual field defect during awake surgery for epilepsy or tumor.Copyright © 2016 Elsevier Inc. All rights reserved.

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