Introduction Language mapping during awake craniotomy is the gold standard for maximising extent of resection while limiting language deficits. However, there is variation in the type and mode of delivery of language tests. Here we conduct a systems analysis for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy.

Methods Mixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using Failure Modes and Effects analysis.

Results 12 research articles describing 6 technologies which required a range of hardware components including virtual reality headsets and integrated multi-screen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies. Of 37 awake craniotomy teams from 14 countries, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. Commonest devices were tablets (67.7%; n=21) and the commonest software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery.

Conclusions This work represents a rigorous systema approach to the development of a digital platform for standardised intraoperative language testing during awake craniotomy and for collaborative brain mapping.