经Dolenc入路治疗颅内复杂部位动脉瘤17例临床分析

Clinical analysis of anatomical complicated intracranial aneurysms using Dolenc approach ： report of 17 cases

目的探讨采用Dolenc入路开颅手术治疗颅内复杂部位动脉瘤的临床效果。方法回顾性分析2014年11月-2016年1月，首都医科大学附属北京天坛医院神经外科经Dolenc入路开颅手术夹闭治疗的17例颅内复杂部位动脉瘤患者的临床资料，其中男7例、女10例，年龄41-72岁，包括颈内动脉床突段动脉瘤4例、眼动脉段动脉瘤8例、基底动脉顶端动脉瘤1例、大脑后动脉动脉瘤2例、前循环合并后循环多发动脉瘤2例（均一次手术夹闭）。结果17例患者完全夹闭动脉瘤；除2例患者术后出现同侧动眼神经麻痹，其中1例患者出现同侧额叶梗死灶外，其他患者术后均未出现并发症。所有患者术后6个月门诊复诊，均未见动脉瘤复发，未见手术后遗症，格拉斯哥预后评分平均为4．8分。结论对于颅内一些特殊部位动脉瘤的开颅手术夹闭治疗，相对于传统的入路方式，Dolenc入路具有明显的优势，手术的安全性高。

Objective To discuss the clinical outcomes of surgical treatment for anatomical complicated intracranial aneurysms using Dolene approach. Methods Seventeen patients （7 males and 10 females, mean age 41 -72） with anatomical complicated intracranial aneurysms admitted to Beijing Tian Tan Hospital of Capital Medical University from November 2014 to January 2016 were reviewed, including g paraelinoid aneurysms, 8 carotid artery-ophthalmic artery aneurysms, 1 basilar tip aneurysm, 2 posterior cerebral artery aneurysms, and 2 multiple intracranial aneurysms. All patients were treated with aneurysm clipping using Dolenc approach, including 2 patients with multiple intraeranial anenrysms which were clipped in one operation. Results All aneurysms were clipped completely, patients discharged without any complication except two patients occurred with oculomotor paralyses and one patient with cerebral infarction in the frontal lobe after operation. All patients were followed up for 6 month with satisfactory prognosis with mean glasgow outcome scale 4.8. Conclusions Dolenc approach is more practical and safer for the surgical treatment of anatomical complicated intracranial aneurysms compared to traditional approach.