Delion Matthieu, Klinger Evelyne, Bernard Florian, Aubin Ghislaine, Minassian Aram Ter, Menei Philippe
Department of Neurosurgery, University Hospital of Angers, Angers, France.
French Institute for Research on Handicap (IFRH), France, EA4136, University of Bordeaux, Bordeaux, France.
World Neurosurg. 2020 Feb;134:e937-e943. doi: 10.1016/j.wneu.2019.11.047. Epub 2019 Nov 14.
Brain mapping by direct electrical stimulation during awake craniotomy is now a standard procedure that reduces the risk of permanent neurologic deficits. Virtual reality technology immerses the patient in a virtually controlled, interactive world, offering a unique opportunity to develop innovative tasks for perioperative mapping of complex cognitive functions. The objective of this prospective single-center study was to evaluate the tolerance and safety of a virtual reality headset (VRH) and immersive virtual experiences in patients undergoing awake craniotomy and brain mapping by direct electrical stimulation.
The study included 30 patients with a brain tumor near the language area. Language mapping was performed with a naming task, DO 80, presented on a digital tablet and then in two-dimensional and three-dimensional formats through a VRH. During wound closure, different virtual reality experiences were proposed to the patient, offering different types of virtual motion or interaction with an avatar piloted by a neuropsychologist.
Two patients could not use the VRH owing to technical issues. No procedure was aborted, no patient experienced virtual reality sickness and all patients reported they would repeat the procedure. Despite a high rate of intraoperative focal seizures, there was no argument to attribute the seizures to VRH use.
This study shows that it is possible during awake brain surgery to immerse the patient in a virtual environment and to interact with the patient, opening the field of new brain mapping procedures for complex cognitive functions.
清醒开颅手术期间通过直接电刺激进行脑图谱绘制现已成为一种标准程序，可降低永久性神经功能缺损的风险。虚拟现实技术将患者沉浸在一个虚拟控制的交互式世界中，为开发用于复杂认知功能围手术期图谱绘制的创新任务提供了独特机会。这项前瞻性单中心研究的目的是评估虚拟现实头戴设备（VRH）和沉浸式虚拟体验在接受清醒开颅手术和通过直接电刺激进行脑图谱绘制的患者中的耐受性和安全性。
该研究纳入了30名语言区域附近有脑肿瘤的患者。使用数字平板电脑上呈现的命名任务DO 80进行语言图谱绘制，然后通过VRH以二维和三维形式呈现。在伤口缝合期间，向患者提供不同的虚拟现实体验，提供不同类型的虚拟运动或与由神经心理学家操控的化身进行互动。
两名患者因技术问题无法使用VRH。没有手术中止，没有患者出现虚拟现实不适，所有患者均表示愿意重复该过程。尽管术中局灶性癫痫发作率很高，但没有证据表明癫痫发作与使用VRH有关。
这项研究表明在清醒脑部手术期间将患者沉浸在虚拟环境中并与患者进行互动是可行的，这为复杂认知功能的新脑图谱绘制程序开辟了领域。
