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ObjectivesThe diagnosis of vocal fold cancer currently relies on invasive surgical biopsies, which can compromise laryngeal function. Distinguishing between different types of laryngeal lesions without invasive tissue sampling is therefore crucial. Autofluorescence spectroscopy (AFS) has proved to be efficient as a non-invasive detection technique but has yet to be fully exploited in the context of a multi-class tissue analysis. This study evaluates whether AFS can be used to discriminate between different types of laryngeal lesions in view of assisting in vocal fold surgery and preoperative investigations.Materials and methodsEx vivospectral autofluorescence scans were recorded for each sample using a 405-nm laser excitation. A total of 1308 spectra were recorded from 29 vocal fold samples obtained from 23 patients. Multiclass analysis was conducted on the spectral data, classifying lesions either as normal, benign, dysplastic, or carcinoma. The results were compared to histopathological diagnosis.ResultsThrough an appropriate selection of spectral components and a cascading classification approach based on artificial neural networks (ANN), a classification rate of 97% was achieved for each lesion class, compared to 52% using autofluorescence intensity.ConclusionThe study demonstrates the effectiveness of AFS combined with multivariate analysis for accurate classification of vocal fold lesions. Comprehensive spectral data analysis significantly improves classification accuracy, even in challenging situations such as distinguishing between malignant and premalignant or benign lesions. This method could provide a way to performin situmapping of tissue states for minimally-invasive biopsy and surgical resection margins.

Number: 3 PMID: 33555752; OBJECTIVES: Cholesteatoma is an inflammatory disease, frequently observed in childrens and young adults, with a risk of relapse or recurrence. The few studies which analyzed cholesteatoma localization on magnetic resonance imaging (MRI) usually merged CT-MR images or relied on their authors' anatomical knowledge. We propose a compartmental reading method of the compartments of the middle ear cavity for an accurate localization of cholesteatomas on MR images alone. MATERIAL AND METHODS: Our method uses easily recognizable anatomical landmarks, seen on both computed tomography (CT) and MRI, to delimit the middle ear compartments (epitympanum, mesotympanum, hypotympanum, retrotympanum, protympanum, antrum-mastoid cavity). We first tested it on 50 patients on non-enhanced temporal bone CT. Then, we evaluated its performances for the localization of cholesteatomas on MRI, compared with surgery on 31 patients (validation cohort). RESULTS: The selected anatomical landmarks that delimited the middle ear compartments were applicable in 98 to 100% of the cases. In the validation cohort, we were able to accurately localize the cholesteatoma on MRI in 83% of the cases (n = 26) with high sensitivity (95.7%) and specificity (98.6%). CONCLUSION: With our compartmental reading method, based on the recognition of well-known anatomical landmarks to differentiate the compartments of the middle ear cavity on MRI, we were able to accurately localize the cholesteatoma with high (>90%) sensitivity and specificity. Such landmarks are widely applicable and only require limited learning time based on key images. Accurate localization of the cholesteatoma is useful for the choice of surgical approach.

International audience; Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.

We report on the fabrication of micro-axicons made of glass by laser-assisted wet etching (LAE) and laser polishing. The employed technique, relying on a direct-writing process using a femtosecond laser, allows revealing high fidelity profiles when the exposed glass samples are etched in a heated potassium hydroxide (KOH) solution. The remaining surface roughness is then decreased by carbon dioxide (CO2) laser polishing. Such polishing is limited to the superficial layer of the component so that the tip is only slightly rounded, with a radius of curvature of nearly 200 µm. It is then shown with 500 µm-diameter axicons that a quasi-Bessel beam is generated closely after the tip and features a 5.3 µm diameter maintained over a propagation distance of almost 3.5 mm.

International audience; Olfactory dysfunction could be an early and reliable indicator for the diagnosis of neurodegenerative disorders such as Alzheimer and Parkinson's diseases. In this paper, we compare the potential of different noninvasive medical imaging modalities (optical coherence tomography, confocal microscopy, and fluorescence endomicroscopy) to distinguish how the olfactory epithelium, both at the cellular and the structural levels, is altered. Investigations were carried out on three experimental groups: two pathological groups (mice models with deliberately altered olfactory epithelium and Alzheimer's disease transgenic mice models) were compared with healthy mice models. As histological staining, the three tested noninvasive imaging tools demonstrated the general tubular organization of the olfactory epithelium on healthy mice. Contrary to OCT, confocal microscopy, and endomicroscopy allowed visualizing the inner structure of olfactory epithelium as well as its morphological or functional changes on pathological models, alterations classically observed with histological assessment. The results could lead to relevant development of imaging tools for noninvasive and early diagnosis of neurodegenerative diseases through the in situ characterization of the olfactory epithelium.

International audience; Inspecting the olfactory cleft can be of high interest, as it is an open access to neurons, and thus an opportunity to collect in situ related data in a non-invasive way. Also, recent studies show a strong link between olfactory deficiency and neurodegenerative diseases such as Alzheimer and Parkinson diseases. However, no inspection of this area is possible today, as it is very difficult to access. Only robot-assisted interventions seem viable to provide the required dexterity. The feasibility of this approach is demonstrated in this article, which shows that the path complexity to the olfactory cleft can be managed with a concentric tube robot (CTR), a particular type of continuum robot. First, new anatomical data are elaborated, in particular for the olfactory cleft, that remains hardly characterized. 3D reconstructions are conducted on the database of 20 subjects, using CT scan images. Measurements are performed to describe the anatomy, including metrics with inter-subject variability. Then, the existence of collision-free passageways for CTR is shown using the 3D reconstructions. Among the 20 subjects, 19 can be inspected using only 3 different robot geometries. This constitutes an essential step towards a robotic device to inspect subjects for clinical purposes.

International audience; Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic applications.

Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.The authors present a 71-year-old woman with a 6-month history of left cranial nerve palsy. Magnetic resonance imaging and positron emission tomography-computed tomography showed an enhancing isolated lesion at the PPF. A transmaxillary biopsy was performed, leading to diagnosis of primitive squamous cell carcinoma. The patient underwent radiotherapy treatment.Primitive tumors of PPF are rare and diagnosis may be difficult. Endoscopic access for diagnosis can be performed. Squamous cell carcinoma occurring in PPF is associated with poor prognosis.

BACKGROUND Bone conduction implants based on abutment-driven acoustic transmission result in good hearing outcomes; however, skin complications impact the quality of life (QOL) and possibly the viability of the device for many patients. The transcutaneous magnetic Baha® Attract technology was developed with the goal of minimising skin complications. OBJECTIVES To analyse surgical, auditory and QOL outcomes for patients implanted with the Baha® Attract. DESIGN Prospective multicentre cohort study. SETTING Four French tertiary referral centres. PARTICIPANTS Thirty-two patients implanted with the Baha® Attract, including 25 with conductive and mixed hearing loss and 7 with single-sided deafness. MAIN OUTCOME MEASURES Postoperative follow-up involved the visual analysis of soft tissue adaptation and sound processor magnet strength measurement. The audiometric outcomes were evaluated in quiet and noise, and the QOL was assessed using three different questionnaires. RESULTS After 12 months of use, soft tissue was thinner, and mean magnet strength was significantly decreased (3.7-3.1, P

International audience; This paper deals with the design, modeling and control of a compact endoscopic tip for laser steering. It consists of a two degrees-of-freedom (DOF) microrobotic device based on two linear piezoelectric motors associated with a deformable microfabricated Silicon mirror. The proposed device is integrated into an endoscopic tip for microrobot-assisted vocal fold laser microsurgery. The laser motions on the target tissue are controlled using the microrobot device and through a path following scheme combined with a visual servoing controller. Indeed, the surgeon defines, using a tablet, a path to be followed automatically by the laser at high frequency and under a predefined fixed velocity. The developed device was validated successfully in both realist testbench and preclinical cadaver trials.

The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain.Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group "cluster headache" (CH), group "persistent idiopathic facial pain" (PFIP), and group "Other". Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol.Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate.Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain.

The ENDOTANIL Trial aimed at comparing an association of target-controlled infusion (TCI) of remifentanil and propofol to TCI of propofol alone on the clinical conditions during pan endoscopy for assessment of the upper airway (pan endoscopy) performed under tubeless general anesthesia.This double-blind, single center, parallel, randomized, placebo-controlled trial was conducted in a French tertiary level of care, from June 2009 to February 2013. Patients scheduled for elective pan endoscopy were anesthetized using propofol TCI combined to either remifentanil TCI (effect-site concentration=1.5 ng.mL-1; remifentanil group) or placebo (control group). The main outcome measure was the percentage of clinically acceptable conditions for pan endoscopy, using a 5-criteria score (ease of laryngoscopy, position and movements of the vocal cords, cough and movements of the limbs to stimulation). The secondary outcomes were hemodynamic and respiratory safety.In this study 218 patients (mean±SD age 60 [10] yrs) were included. Clinically acceptable conditions were observed in 68% and 64% of the patients included in Remifentanil and Control group, respectively (P=0.39). None of the 5 parameters of the pan endoscopy score was significantly different between the 2 groups. Hemodynamic alterations were significantly lower in the Remifentanil as compared to the control group. Incidence of hypoxemia or need for rescue mechanical ventilation did not significantly differ between the 2 groups.The adjunction of remifentanil to propofol TCI, at a dose that maintain spontaneous breathing, did not improve the conditions for pan endoscopy, but attenuates the hemodynamic response induced by upper airway stimulation.

OBJECTIVE: To assess the risk of home accidents related to severe hyposmia. METHODS: A questionnaire, completed by 57 hyposmic patients and 49 control subjects with a normal sense of smell, asked about four specific types of olfactory-related home accidents: undetected fires, undetected gas leaks, consumption of spoiled food, and incidents of food burning. Level of olfactory function was determined by olfactory testing (Biolfa((R))). RESULTS: Olfactory testing revealed that 60% of the patients were anosmic and 40% had severe hyposmia. They reported cooking-related accidents most often (63%), followed by eating spoiled food (51%), inability to detect a gas leak (47%) and inability to smell a fire (26%). All these accidents were significantly more frequent than in the control population (p Language: fr

Computed tomography (CT) in nasal polyposis (NP) patients has three functions before any treatment. CT provides objective evidence of the disease and precise topography of the disease, and is an indicator of the disease severity. After functional endoscopic sinus surgery (FESS), CT is an indicator of the residual disease severity and permits detection of asymptomatic mucoceles.NP affects nearly 4% of the population. CT has become the examination of choice for the exploration of NP. FESS is accepted for NP treatment in the setting of failure of medical management. The aim of this study was to find out whether any correlation exists between symptom severity and CT scan score before and after FESS.A total of 114 CT scans were performed in NP patients without contrast medium before and after FESS (mean follow-up 5 years), and were scored according to the Lund-MacKay system.Lund-MacKay scores before treatment ranged from 8 to 24. There was a correlation between symptom and CT scores before any treatment. Postoperative Lund-MacKay scores ranged from 0 to 24. There was a correlation between symptom and CT scores after surgery. There was no correlation between postoperative symptom and baseline CT scores. Eleven asymptomatic mucoceles were found.

Primary spontaneous cerebrospinal fluid leaks occurring in the absence of any apparent cause are rare. Patients may present such leaks simultaneously, or successively, in multiple locations. We report here the sixth case of anterior and lateral skull base defects presented in a single patient. Although rhinoliquorrhea and otoliquorrhea were reported separately in the literature, we postulated that the pathophysiology is the same for the whole skull base; obesity seems to contribute to the development of such primary spontaneous cerebrospinal fluid leak. Consequently, management is similar and regular follow-up is very important.

Objectives This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besancon from 2001 to 2007. Materials and methods All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40 dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management. Results Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500 g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss. Conclusion Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.

To assess the risk of home accidents related to severe hyposmia.A questionnaire, completed by 57 hyposmic patients and 49 control subjects with a normal sense of smell, asked about four specific types of olfactory-related home accidents: undetected fires, undetected gas leaks, consumption of spoiled food, and incidents of food burning. Level of olfactory function was determined by olfactory testing (Biolfa).Olfactory testing revealed that 60% of the patients were anosmic and 40% had severe hyposmia. They reported cooking-related accidents most often (63%), followed by eating spoiled food (51%), inability to detect a gas leak (47%) and inability to smell a fire (26%). All these accidents were significantly more frequent than in the control population (p10(-4)).This paper, the first in the European literature and the second in the international literature, shows that patients with severely impaired olfaction are more likely to experience related accidents than those with normal olfactory function.

This letter presents a hybrid concentric tube robot which covers the middle ear volume for exhaustive ablation of residual cholesteatoma. The proposed robotic system combines a concentric tube robot and a wrist at the distal end, actuated by a tendon. We first introduce the surgical protocol through two access points (ear canal and few millimeters size hole through the mastoid), then derive the anatomical constraints and specify the robot tasks. Based on the robot model enriched with the optical fiber stiffness and on anatomical constraints, the robot parameters are determined as the ones among discretized sets that provide the maximal volume coverage. Experiments are conducted with a benchtop prototype on a 3D printed middle ear phantom to validate the wrist model with the optical fiber and the robot repeatability assessment. The wrist model achieved an root mean square error (RMSE) of 1.33 deg and R2 = 96.8%. The robot repeatability has an RMSE of 0.7 mm for distance errors and 1.34 - 2.42 - 3.11 deg for the angular ones. We finally demonstrated the ablation of cholesteatoma by the embedded optical fiber on the hybrid concentric tube robot prototype.

A disease called cholesteatoma affects the middle ear, in the absence of treatment, it could lead to serious complications. The only treatment in current medical practice is a surgical procedure. Incidences of residual or recurrent cholesteatoma are high and the patient may have more than one surgical procedure. Therefore, a novel robotic system was proposed to eliminate the incidence of residual cholesteatoma by removing efficiently all infected cells from the first surgery, and make a less invasive surgery. Thus, this manuscript shows the different challenges that face the surgeon through such a micro-procedure. It also is specified the requirements for achieving a futuristic system dedicated to cholesteatoma surgery. In addition, a controller is proposed as a first step toward the ideal system. Such a controller allows to guide a rigid surgical tool for following a reference path under the constraints of the incision hole. The proposed controller can guide either a straight tool or a curved one. Indeed, the proposed controller is a high level control which is formulated in the task-space (or Cartesian-space). This controller is a modular layer which can be added to different robotics structures. The proposed controller showed a good results in term of accuracy while assessed on a parallel robot and a serial one.; Une maladie appelée cholestéatome affecte l'oreille moyenne, en absence de traitement, elle pourrait conduire à des complications graves. Le seul traitement dans la pratique médicale actuelle est une procédure chirurgicale. Les incidences de cholestéatome résiduelle ou récurrente sont élevés et le patient doit subir plus d'une intervention chirurgicale. Par conséquent, un système robotique original a été proposé pour d'éliminer l'incidence du cholestéatome résiduel en enlevant efficacement toutes les cellules infectées de la première intervention chirurgicale, et de faire une chirurgie moins invasive. Ainsi, ce manuscrit montre les différents défis auxquels fait face le chirurgien à travers une telle micro-procédure. Il est également défini le cahier de charge pour la réalisation d'un système futuriste dédié à la chirurgie du cholestéatome. En outre, un contrôleur est proposé comme un première étape vers le système idéal. Un tel contrôleur permet de guider un outil chirurgical rigide afin de suivre un chemin de référence sous les contraintes du trou d'incision. Le contrôleur proposé peut guider soit un outil droit, soit un outil courbe. En effet, le contrôleur proposé est une commande de haut niveau qui es formulé dans l'espace de tâche (ou espace Cartésien). Ce contrôleur est une couche modulaire qui peut être ajoutée à différentes structures robotiques. Le contrôleur proposé a montré de bons résultats en termes de précision tout en étant évalué sur un robot parallèle et un robot en série.

A disease called cholesteatoma affects the middle ear, in the absence of treatment, it could lead to serious complications. The only treatment in current medical practice is a surgical procedure. Incidences of residual or recurrent cholesteatoma are high and the patient may have more than one surgical procedure. Therefore, a novel robotic system was proposed to eliminate the incidence of residual cholesteatoma by removing efficiently all infected cells from the first surgery, and make a less invasive surgery. Thus, this manuscript shows the different challenges that face the surgeon through such a micro-procedure. It also is specified the requirements for achieving a futuristic system dedicated to cholesteatoma surgery. In addition, a controller is proposed as a first step toward the ideal system. Such a controller allows to guide a rigid surgical tool for following a reference path under the constraints of the incision hole. The proposed controller can guide either a straight tool or a curved one. Indeed, the proposed controller is a high level control which is formulated in the task-space (or Cartesian-space). This controller is a modular layer which can be added to different robotics structures. The proposed controller showed a good results in term of accuracy while assessed on a parallel robot and a serial one., Une maladie appelée cholestéatome affecte l'oreille moyenne, en absence de traitement, elle pourrait conduire à des complications graves. Le seul traitement dans la pratique médicale actuelle est une procédure chirurgicale. Les incidences de cholestéatome résiduelle ou récurrente sont élevés et le patient doit subir plus d'une intervention chirurgicale. Par conséquent, un système robotique original a été proposé pour d'éliminer l'incidence du cholestéatome résiduel en enlevant efficacement toutes les cellules infectées de la première intervention chirurgicale, et de faire une chirurgie moins invasive. Ainsi, ce manuscrit montre les différents défis auxquels fait face le chirurgien à travers une telle micro-procédure. Il est également défini le cahier de charge pour la réalisation d'un système futuriste dédié à la chirurgie du cholestéatome. En outre, un contrôleur est proposé comme un première étape vers le système idéal. Un tel contrôleur permet de guider un outil chirurgical rigide afin de suivre un chemin de référence sous les contraintes du trou d'incision. Le contrôleur proposé peut guider soit un outil droit, soit un outil courbe. En effet, le contrôleur proposé est une commande de haut niveau qui es formulé dans l'espace de tâche (ou espace Cartésien). Ce contrôleur est une couche modulaire qui peut être ajoutée à différentes structures robotiques. Le contrôleur proposé a montré de bons résultats en termes de précision tout en étant évalué sur un robot parallèle et un robot en série.

Over the past 20 years, the use of imaging guidance has progressively but very rapidly evolved to become a standard practice to date, with fluoroscopy and Ultrasound being the most popular imaging guiding tools. However, CT guidance is relatively underused in the field of Interventional pain management, mainly due to acces and availabilty issues for pain physicians. Therefore, the objective of this thesis are mulitple :* to evaluate the usefulness of CT scan guidance, in applying existing neurolytic techniques(block.infiltration and neurolysis) to innovative indications, allowed by the use of such an imagingguiding tool.* to evaluate the clinical effectiveness of these novel indications* Finally, to emphasize on the importance of the clinical aspects of Interventional pain managementAfter after having reminded the definitions of the different existing techniques (neural blocks, infiltration, neurolysis) and detailed existing materials (Local anesthestics, Steroids, Chemical Neurolysis, Physical Neurolysis), a brief description of existing indication of Interventional Pain will be made. Emphasis will then be made on the assessment of innovative interventional CT Guided pain techniques in various refractory pain syndromes :- Evaluation of Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio facial pain , in 42 patients : overall efficacy rate of alcohol SPN was 67.2% with a mean pain relief duration of 10,3 months. Analysis showed a higher efficacy rate in patients with Cluster Headaches (76.5%) andPersisting Facial Idiopathic Pain (85.7%)- Evaluation of the efficacy of a simplified CT guided greater occipital nerve (GON) infiltration approach inthe management of occipital neuralgia (ON) in 33 patients : Clinical success rate was 86%. In case of clinicalsuccess, mean pain relief duration following procedure was 9.16 months.- Evaluation of CT-guided Stellate Ganglion Blockade vs. Radiofrequency Neurolysis in the Managementof Refractory type I Complex Régional Pain Syndrome of the Upper Limb in 67 patients : analysis performed onthe blockade and RFN groups showed a significantly (P, Au cours des 20 dernières années, l'utilisation de méthode de guidage par imagerie s'est progressivemen imposé comme gold standar dans nombre d'indications Interventionel antidouleur. Les modalités de guidage els plus utilisés sont la fluoroscopie et l'échographie. Le Scanner est relativement sous-utilisé dans le domaine de la prise en charge interventionnelle de la douleur, principalement en raison des difficultés d'accès et de Disponibilités pour les praticiens de la douleur. Au travers de cette thèse, nous avons montré l'intérêt du guidage scanner dans plusieurs indications avec de bons résultats, grâce à des techniques innovantes* L'Évaluation de l'alcoolisation percutanée du ganglion sphéno-palatin dans la prise en charge de ladouleur cranio-faciale réfractaire, chez 42 patients avec taux d'efficacité globale d'alcoolisation du GSP de67,2% et une durée moyenne de soulagement de la douleur de 10,3 mois. L'analyse a montré un tauxd'efficacité élevé chez les patients avec des algies vasculaires de la face (76,5%) et des syndromesdouloureux faciaux persistent (85,7%)* L' Évaluation de l'efficacité d'un méthode simplifiée d'infiltration sous scanner du nerf grandoccipital (NGO) chez 33 patients souffrant d'une névralgie occipitale avec taux de succès clinique de 86%.En cas de succès clinique, la durée moyenne de soulagement de la douleur suivant la procédure était de9,16 mois.*La comparaison deu block vs. neurolyse par radiofréqence du ganglion stellaire sous guidage scannographique dans la prise en charge du Syndrome Douloureux Régional Complexe de Type 1 du membre supérieur chez 67 patients: on retrouve une efficacité supérieure dans le groupe RFN (67,6%, 23/34) par rapport au groupe de block (21,2%, 7/33) avec un OR de 7,76.* L'Évaluation de la neurolysepar RF des nerfs ilio-inguinal et ilio hypogastrique chez les patients souffrant de douleurs ilio-inguinal et à l'aine réfractaire.• pouvait conduire à une amélioration des résultats. Dans tous les cas, le guidage par Scanner est une valeur ajoutée dans certaines indications, car elle permet en toute sécurité, le placement précis, millimétrique, de l'aiguille. Une autre solution possible afin de réduire les risques liés à certains gestes serait le développement d'une L'Étude préliminaire sur 16 patients traités par RFN a montré une réduction significative dela douleur après RFN pendant 11,8 mois.• Une deuxième étude a été menée permettant de comparer l'efficacité de la RFN et à cellede l'infiltration dans la même indication chez 42 patients: La durée moyenne de soulagementde la douleur était statistiquement supérieure (P = 0,005) dans le groupe RF (12,5 mois)comparé au groupe d'infiltration (1,6 mois).Au cours de ces études publiées, nous avons montré que l'application d'une technique existante (neurolyse, infiltration) à une nouvelle indication, ou la modification d'une technique existante après des considérations anatomiques sonde de radiofréquence unidirectionnel, capable de créer une zone d'ablation en demi sphère dont l'orientation serait contrôlable, ce qui permettrait de réduire les risques d'ablation non désirée.Enfin, il est important de rappeler, que la prise en charge interventionnelle de la douleur d'un patient s'intègre dans une prise en charge globale, centrée autour du patient. Ainsi, la prise en charge d'un patient douloureux ne pourra se faire de manière efficace qu'en prenant en compte l'ensemble des aspects de la douleur exprimé par le patient, bien au delà des seules considérations techniques d'un geste interventionnel.