Zhao Yahui, Zhang Qian, Zhang Dong, Wang Shuo, Zhang Yan, Zhao Yuanli
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6th Tiantanxili, Beijing 100050, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6th Tiantanxili, Beijing 100050, China.
J Clin Neurosci. 2019 Mar;61:142-146. doi: 10.1016/j.jocn.2018.10.105. Epub 2018 Nov 13.
Blood blister-like aneurysms (BBAs) were considered a great therapeutic challenge with high morbidity and mortality. A variety of microsurgical techniques to treat BBAs had been proposed, but few had investigated the optimal surgical approach toward the exposure of BBAs. In this study, we aimed to compare the advantages and disadvantages of Dolenc and pterional approach in the microsurgery of BBAs.
We retrospectively reviewed medical and surgical records of ICA (internal carotid artery) blister-like aneurysms that had been treated by microsurgery at our hospital during 2012 to 2017 and compared postoperative complications and outcomes between Dolenc and pterional approach.
Seventeen BBAs of 16 patients with complete information were identified from our database based on intraoperative findings. All 17 BBAs were treated with direct clipping successfully with no death or re-bleeding occurred. Six patients were performed with Dolenc approach and 10 with pterional approach. No significant difference was found regarding the incidence of intraoperative rupture (42.9% vs 0.0%, P = 0.051) or postoperative complications (ocular complications:33.3% vs 0.0%, P = 0.125; ischemic events: 33.3% vs 10.0%, P = 0.518) between the two groups.
Dolenc approach and pterional approach were both applicable craniotomies for supraclinoid BBAs of ICA. Dolenc approach provided more exposure of ICA trunk, which ensured reliable proximal control but might also bring higher risk of oculomotor paralysis. Choice of approach should be based on the location of BBA and the available form of proximal control.
血泡样动脉瘤（BBAs）被认为是具有高发病率和死亡率的重大治疗挑战。已经提出了多种治疗BBAs的显微外科技术，但很少有人研究暴露BBAs的最佳手术入路。在本研究中，我们旨在比较Dolenc入路和翼点入路在BBAs显微手术中的优缺点。
我们回顾性分析了2012年至2017年期间在我院接受显微手术治疗的颈内动脉（ICA）血泡样动脉瘤的医疗和手术记录，并比较了Dolenc入路和翼点入路术后的并发症及结果。
根据术中发现，从我们的数据库中确定了16例具有完整信息患者的17个BBAs。所有17个BBAs均成功进行了直接夹闭，未发生死亡或再出血。6例患者采用Dolenc入路，10例采用翼点入路。两组之间在术中破裂发生率（42.9%对0.0%，P = 0.051）或术后并发症（眼部并发症：33.3%对0.0%，P = 0.125；缺血事件：33.3%对10.0%，P = 0.518）方面未发现显著差异。
Dolenc入路和翼点入路均适用于ICA床突上段BBAs的开颅手术。Dolenc入路能更多地暴露ICA主干，确保可靠的近端控制，但也可能带来更高的动眼神经麻痹风险。手术入路的选择应基于BBAs的位置和近端控制的可用形式。
