Wearable video display allowing freedom in head positioning for brain mapping.

Awake brain mapping is the gold standard for localization of dominant-hemisphere cortical language functions and in the appropriately selected patient, it may allow the surgeon to avoid eloquent cortex and/or perform a more aggressive surgery of lesions situated in adjacent non-eloquent cortex1-3. For intraoperative object naming, the patient is most commonly placed in the lateral position providing them an unobstructed view of a screen with the object to be named4. This is largely due to the fact that the majority of cases in which language mapping is performed are in the temporal or inferior frontal lobe. However if the choice of positioning is not lateral, yet language mapping would be preferable, some positions may make it difficult or impossible to view objects on a screen. At Toronto Western Hospital in Toronto, Canada, we have found utility in the use of a wearable video display when mapping cortical language function, either routinely in temporal and frontal regions, or in positions not typically employed in standard temporal cases. In this article, we describe the basic setup of this device, focus on the key procedural steps required to replicate this setup, describe our experience with this technique and highlight some of the important anesthetic considerations.