采用Dolenc入路处理海绵窦病变

目的 探讨海绵窦手术入路方法，以期提高手术效果。方法 在8个尸头上（16侧）按Dolenc手术入路的基本要领进行解剖练习，应用于临床12例，其中10例为海绵窦内肿瘤（脑膜瘤5例，垂体瘤3例，脊索瘤2例），1例为累及海绵窦的眼动脉巨大动脉瘤，1例为海绵窦段颈内动脉巨大动脉瘤。结果 Dolenc手术入路主要分两步；首先从硬膜外去除遮挡海绵窦的部分骨质（前床突，蝶骨翼等），然后将海绵窦上壁和外侧壁的硬膜广泛剥离开，暴露其深面的颅神经。采用此入路，10例海绵窦内肿瘤有5例全切。3例近全切，动脉瘤顺利夹闭，除2例持久的外展神经麻痹，未带来新的神经功能缺损。结论 Dolenc手术入路显露充分，安全，为彻底根除某些海绵窦病变提供了机会。

Surgical treatment of intracavernous lesions using Dolenc approach

Objective To study the surgical approach to the cavernous sinus and improve the operative outcomes.Methods Dolenc technique for exploration of cavernous sinus was reviewed and practiced on 8 cadaveric heads(16 sides),and then applied for 12 patients, among them 10 had intracavernous tumors(meningiomas in 5,pituitary adenomas in 3,chordomas in 2),1 had a large ophthalmic aneurysm invading into the cavernous sinus,1 had a giant intracavernous aneurysm.Results Dolenc approach includes mainly two phases:to remove the bony structures (anterior clinoid process, sphenoid wing,etc.)confining portions of the cavernous sinus epidurally, and then to split the dural layer of the superior and lateral walls,exposing underneath cranial nerves.Using this technique, we reached total removal of the tumor in 5 cases, nearly total removal in 3,and clipped the aneurysms successfully, without new neurological deficits except for permanent abducent palsy in 2 cases.Conclusions Dolenc approach provides another opportunity to cure the lesions of cavernous sinus in selected patients for its safe and wide exposing perculiarity.