Table 1.

Technologies for the delivery of language tests during awake craniotomy

Technology	Country	Year	Summary of technology	Hardware and software requirements	Reported language tests	Other cognitive tests and functionality	Stakeholder feedback	Clinical validation
Personal digital assistant19	Japan	2006	Delivery of intraoperative naming tasks using PDA	Handy PDA (Sony Clie PEG−TJ25) with square (55×55 mm), back-lighted LCD and switch to facilitate changing the displayed object. Objects prepared using Microsoft PowerPoint	Object naming	None reported	None reported	3 patients
Intraoperative examination monitor for awake surgery27–29	Japan	2010	Intraoperative brain mapping monitor	CCD camera, 3.5-inch LCD monitor for patient and 7.5-inch LCD monitor for operator. Seven integrated parameters on the monitor: patient face and eyes, anatomical data from neuronavigation system, view of microscopic surgical field, test object, BIS, general view of operating theatre, heartbeat monitor	Object naming	Recording of patient’s face, voice, heart rate and displays BIS	Nine neurosurgeons participated in simulation using monitor technology (no patients)	2011: 220 patients across two modifications of IEMAS
Brain Mapping Interactive Stimulation System8 26	China	2015	Intraoperative brain mapping iintegrated task-presentation platform	Flexible and portable task presentation system including speakers to amplify patient responses, hand and foot monitoring and various interfaces (surgeon, technician, software and patient). Language tasks presented on slides projected onto a screen.	Object naming; listening comprehension; reading; number counting	Multivideo recording of patient behavior, including hand and foot monitoring. Speakers to amplify responses	None reported	2015: 66 patients 2021: 48 patients
NeuroMapper24 25	USA	2016	Intraoperative language and cognitive mapping using iPads	Tablet-based testing platform (NeuroMapper)—initially developed in 2016. Uses a dual iPad interface—one is patient-facing for the patient to see stimuli and the other is examiner facing for administration of the tasks	Object naming; auditory descriptive naming; famous face naming; non-word repetition; single word reading; writing	Unspecified cognitive testing	None reported	2020: 1 patient 2021: 15 patients
Novel tablet platform20	Canada	2016	For use during both pre-operative fMRI language mapping and DCES during awake craniotomy for glioma resection	fMRI-compatible tablet, including a touch-sensitive surface and optional stylus. Stimulus computer with flexible software (E-Prime, Psychology Software Tools) to program and execute behavioral tests, receive and quantify tablet data Adjuncts for intraoperative use: 5-inch LCD display (Ikan VL5), video cameras (monitoring the patient’s face, hand, foot and brain)	Number counting; word generation (verbal and written); word-copying task; tongue-movement task	Video recording of the patient’s face, hand, foot and brain	None reported	4 patients
Virtual reality21–23	France	2018	Delivery of intraoperative language and social cognition mapping using virtual reality technology	Interaction with an avatar using vTime app (a social network in VR). Allows creating an avatar socializing with other people in virtual environments. Hardware used was the Samsung Gear VR and Samsung S7 smartphone (android platform) with headphones. And the use of Tobii Pro VR Integration—an eye-tracking retrofitted HTC VIVE wired to a computer connected to a Brainlab neuronavigation system	Object naming (DO 80 duplicated in VRH in 2D and in stereoscope—using Unity 3D software); fluency by commenting on neuropsychologist’s avatar	Social cognition exercise; VR experience with a relaxing film at end of tumor resection during wound closure; eye tracking; tracking head orientation	Patient and medical professionals, assessing tolerance and satisfaction	2018: 3 patients 2020: 30 patients 2021: 15 patients

BIS, bispectoral index; CCD, charge coupled device; DCES, direct cortical electrical stimulation; fMRI, functional MRI; IEMAS, intraoperative examination monitor for awake surgery; LCD, liquid crystal display; MISS, Mapping Interactive Stimulation System; VR, virtual reality; VRH, virtual reality headset.