Microsurgical treatment of paraclinoid aneurysms through Dolenc approach

Abstract

Objective To investigate the surgical skills and clinical efficacy of microsurgical treatment of paraclinoid aneurysms via Dolenc approach. Methods The clinical data of 35 patients with paraclinoid aneurysms operated via Dolenc approach at Department of Neurosurgery, Shiyan Taihe Hospital from September 2014 to May 2018 were analyzed retrospectively. The 35 patients had 38 paraclinoid aneurysms, among which 13 were ruptured aneurysms (Hunt-Hess grade Ⅰ-Ⅲ) and 22 were unruptured.All patients underwent operation via pterional approach and paraclinoid aneurysms were exposed via Dolenc approach. In this study, 24 aneurysms were clipped directly and 11 were clipped and shaped. The intraoperative indocyanine green (ICG) angiography was performed to confirm the efficacy. Results Satisfactory results were achieved in 35 cases. All aneurysms were completely clipped which were confirmed by CT angiography or digital Subtraction angiography examination. Two patients with giant aneurysms developed cerebral infarction and mild hemiplegia on the contralateral side after surgery, which were improved in 1 following rehabilitation treatment. Three patients developed oculomotor nerve palsy which was improved after 3 months. Three patients with ruptured aneurysms had hydrocephalus within 2 months after operation and recovered following ventriculo-peritoneal shunt. All patients were followed up for a period of 1-43 months, with an average of 19±8 months. The GOS (Glasgow outcome scale) grade was Ⅴ in 29 cases, Ⅳ in 5 and Ⅲ in 1 at discharge. Conclusions The removal of anterior clinoid process in extradural space and dissociating distal dural ring via Dolenc approach is favorable for early control of parent artery, may provide a better surgical field for exposing and clipping aneurysms, and thus improve the safety and efficacy of surgical treatment of paraclinoid aneurysms. Key words: Intracranial aneurysm; Microsurgery; Paraclinoid; Dolenc approach