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Électrophysiologie cérébrale associée à la chirurgie éveillée des tumeurs lentes : Couplage de l’ECoG et de la SED pour les investigations peropératoires et analyse de l’EEG postopératoire.

Abstract : Awake surgery is used for the resection of slow-growing and infiltrating brain tumors in awake andfully conscious patients. The neurosurgeon performs intraoperative anatomo -functional mapping ofthe brain applying direct electrical stimulation (DES) on the cortex and the exposed white mattertracts while the patient performs a set of neuropsychological tests. The appearance of behavioraldisturbances consequent to DES allows the identification of still functional tissue and enable theoptimal resection of the tumor, up to the functional limits. However, its use remains empirical and itseffects and the effects of the resection on the cerebral electrophysiology remain unknown. In thiswork, we study the electrophysiological responses evoked by DES thanks to the intraoperativerecording of evoked potentials (EP) on ECoG signals. We also investigate EEG signals collected aftersurgery, in order to identify possible changes in the cerebral electrophysiology induced by theresection. Linear and nonlinear analyses of EEG signals highlighted important alterations of thecerebral dynamics with a normalization of the signals over time, while the measure of EP allowed usto understand better the diffusion of the effects of DES in the brain, more particularly, identifyingdifferent propagation mechanisms of the evoked responses. ECoG and EEG seem to be relevant toolsfor intraoperative exploration and postoperative monitoring of cerebral electrophysiology for patientsundergoing awake surgery.
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Anthony Boyer. Électrophysiologie cérébrale associée à la chirurgie éveillée des tumeurs lentes : Couplage de l’ECoG et de la SED pour les investigations peropératoires et analyse de l’EEG postopératoire.. Autre. Université Montpellier, 2019. Français. ⟨NNT : 2019MONTS050⟩. ⟨tel-02476454⟩

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