Albert van der Zwan1, Peter Vajkoczy2, Sepideh Amin-Hanjani3, Fady T Charbel3, Babu Welch4, Michael Tymianski5, Leena Kivipelto6, Sander van Thoor7, Shamik Chakraborty8, Devon O'Donnell8, David J Langer8. 1. Department of Neurosurgery and Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 2. Department of Neurosurgery, Charité - University Hospital Berlin, Berlin, Germany. 3. Department of Neurosurgery, College of Medicine, University of Illinois, Chicago, Illinois. 4. Department of Neurosurgery, University of Texas Southwestern Medical Center, The University of Texas at Dallas, Dallas, Texas. 5. Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada. 6. Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. 7. Brain Technology Institute, Utrecht, The Netherlands. 8. Department of Neurosurgery, Lenox Hill Hospital, New York, New York.
Abstract
BACKGROUND: Both conventional bypass utilizing temporary recipient vessel occlusion and the excimer laser-assisted nonocclusive anastomosis (ELANA) bypass technique are possible strategies in the treatment of giant aneurysms. These treatments have only been studied in single institutional retrospective studies. The potential advantage of the ELANA technique is the absence of temporary occlusion of major arteries, decreasing the risk of intraoperative ischemia. OBJECTIVE: To investigate the risks and potential benefits of high-flow bypass surgery for giant and complex aneurysms of the anterior cerebral circulation. In addition, the effectiveness of the ELANA bypass procedure in the treatment of these aneurysms is determined. METHODS: A total of 37 patients were included in 8 vascular neurosurgical centers in the United States, Canada, and Europe. A 30-d postoperative bypass follow-up was studied by using digital subtraction angiography and/or magnetic resonance angiography and computed tomography angiography to assess patency as well as by clinical monitoring in all patients. RESULTS: In 35 patients, an ELANA high-flow bypass was performed and the aneurysm treated. Four patients had remaining neurological deficits after 30 d caused by stroke (11.4%). These strokes were not related to the ELANA anastomosis device. CONCLUSION: This study does not prove that the ELANA technique has an advantage over conventional bypass techniques, but it appears to be an acceptable alternative to conventional transplanted high-flow bypass in this very-difficult-to-treat patient group, especially in select patients whom cannot be bypassed using conventional means in which temporary occlusion is considered to be not recommended.
BACKGROUND: Both conventional bypass utilizing temporary recipient vessel occlusion and the excimer laser-assisted nonocclusive anastomosis (ELANA) bypass technique are possible strategies in the treatment of giant aneurysms. These treatments have only been studied in single institutional retrospective studies. The potential advantage of the ELANA technique is the absence of temporary occlusion of major arteries, decreasing the risk of intraoperative ischemia. OBJECTIVE: To investigate the risks and potential benefits of high-flow bypass surgery for giant and complex aneurysms of the anterior cerebral circulation. In addition, the effectiveness of the ELANA bypass procedure in the treatment of these aneurysms is determined. METHODS: A total of 37 patients were included in 8 vascular neurosurgical centers in the United States, Canada, and Europe. A 30-d postoperative bypass follow-up was studied by using digital subtraction angiography and/or magnetic resonance angiography and computed tomography angiography to assess patency as well as by clinical monitoring in all patients. RESULTS: In 35 patients, an ELANA high-flow bypass was performed and the aneurysm treated. Four patients had remaining neurological deficits after 30 d caused by stroke (11.4%). These strokes were not related to the ELANA anastomosis device. CONCLUSION: This study does not prove that the ELANA technique has an advantage over conventional bypass techniques, but it appears to be an acceptable alternative to conventional transplanted high-flow bypass in this very-difficult-to-treat patient group, especially in select patients whom cannot be bypassed using conventional means in which temporary occlusion is considered to be not recommended.
Authors: Albert van der Zwan; Kiki Gortzak; Bart de Boer; Saskia Redegeld; Sander van Thoor; Cornelius Tulleken Journal: Acta Neurochir (Wien) Date: 2022-05-07 Impact factor: 2.816