Comparison of Dolenc and pterional approach in the microsurgery for blood blister-like aneurysms (BBAs) of internal carotid artery
Comparison of Dolenc and pterional approach in the microsurgery for blood blister-like aneurysms (BBAs) of internal carotid artery
复制标题
Dolenc入路与翼点入路显微手术治疗颈内动脉血泡样动脉瘤的比较
DOI：
10.1016/j.jocn.2018.10.105
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Zhao Y
中科院分区：
文献类型：
--
作者：
Zhao Y;Zhang Q;Zhang D;Wang S;Zhang Y;Zhao Y
目的血疱样动脉瘤（bloodblister-like aneurysms，BBAs）是一种高发病率和高死亡率的疾病，治疗难度大。已经提出了各种显微外科技术来治疗BBAs，但很少有人研究暴露BBAs的最佳手术方法。在本研究中，我们的目的是比较Dolenc和翼点入路在显微手术中的优缺点。患者和方法我们回顾性分析了伊卡的医疗和手术记录（颈内动脉）水泡-2012年至2017年期间在我院接受显微手术治疗的动脉瘤，并比较Dolenc和翼点入路的术后并发症和结局。根据术中发现，从我们的数据库中确定了16例信息完整的患者。17例均成功行直接夹闭术，无死亡及再出血发生。6例行Dolenc入路，10例行翼点入路。两组术中破裂发生率（42.9%vs0.0%，P = 0.051）及术后并发症（眼部并发症：33.3%vs0.0%，P = 0.125;缺血性事件：33.3%vs10.0%，P = 0.518）差异均无统计学意义。Dolenc入路暴露伊卡干较多，可保证近端控制可靠，但也可能增加眼麻痹的风险。方法的选择应基于BBA的位置和近端控制的可用形式。
ObjectivesBlood 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.Patients and methodsWe 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.ResultsSeventeen 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.ConclusionDolenc 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.
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