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Étude de la réduction du traumatisme intracochléaire par l'optimisation de l'axe d'insertion lors de l'implantation cochléaire

Abstract : The goals of cochlear implant surgery are to insert the electrode array into the cochlea with minimal intracochlear trauma. The electrode array will then electrically stimulate the ganglion cells of the cochlear nerve and restore hearing in deaf patients. The electrode array insertion has a duration of a few seconds, but the quality of the insertion will influence over the auditory performance of the implant during lifetime. The cochlea is a snailed-shape structure, but an insertion axis can be defined in the basal turn of the cochlea. In a first study, we observed that these anatomical particularities led difficult the cochlear visualization, and to obtain an accurate mental representation of the insertion axis in surgical conditions. In a second work, we observed that only a robotized automated system allowed to precisely align an insertion tool with the insertion axis. In a third work, we used this robotised system to insert the array in a constant speed. Although an optimal insertion axis reduced the intracochlear trauma in relation to an inaccurate axis, the facial nerve is an essential structure that leads to an angle variation between the optimal axis and the scala tympani axis. The size of the angle is finally related to the intracochlear trauma during the electrode array insertion. Once observed the superiority of an optimized technique consisting by both an insertion of the electrode array in an optimal axis and in a constant speed, in the fourth part of this work, we observed that this technique was also less traumatic for the intracochlear structures than a manual insertion technique.
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https://tel.archives-ouvertes.fr/tel-02078793
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Victor Renato Torres Lazo. Étude de la réduction du traumatisme intracochléaire par l'optimisation de l'axe d'insertion lors de l'implantation cochléaire. Physiologie [q-bio.TO]. Sorbonne Université, 2018. Français. ⟨NNT : 2018SORUS001⟩. ⟨tel-02078793⟩

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