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. 2005 Aug;15(3):191-205.
doi: 10.1055/s-2005-872048.

ELANA: Excimer Laser-Assisted Nonocclusive Anastomosis for extracranial-to-intracranial and intracranial-to-intracranial bypass: a review

David J Langer  1 , Peter Vajkoczy
Affiliations

ELANA: Excimer Laser-Assisted Nonocclusive Anastomosis for extracranial-to-intracranial and intracranial-to-intracranial bypass: a review

David J Langer et al. Skull Base. 2005 Aug.

Abstract

ELANA, excimer laser-assisted nonocclusive anastomosis, is a technique using an excimer laser/catheter system for intracranial bypass surgery of the brain. The technique has been developed over the past 12 years by Tulleken and colleagues at UMC Utrecht in The Netherlands for treatment of primarily untreatable giant aneurysms. We review here the emergence of transplanted conduit bypass as a valuable technique for managing these lesions and the subsequent development of ELANA bypass. The ELANA technique allows the operating surgeon to perform an extracranial-to-intracranial or intracranial-to-intracranial bypass using a transplanted large caliber conduit without occlusion of the recipient artery, thus eliminating intraoperative ischemic insult related to temporary occlusion time. We describe the ELANA technique, illustrate it with intraoperative photos, and review the relevant literature. ELANA is shown to be safe; we discuss its advantages over conventional techniques.

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Figures

Figure 1
Figure 1
Suturing of platinum ring to distal end of saphenous vein graft.
Figure 2
Figure 2
(A,B) Left frontal trans-Sylvian approach to supraclinoidal segment of left internal carotid artery (frontal retractor in foreground). Suturing of saphenous graft/ring complex to recipient internal carotid artery.
Figure 3
Figure 3
Catheter tip is designed as shown. Note inner suction portion surrounded by outer excimer laser array.
Figure 4
Figure 4
Laser catheter is placed within graft and advanced to wall of recipient with application of suction followed by laser activation.
Figure 5
Figure 5
(A) Arteriotomy flap is left attached to suction portion of laser tip and (B) is removed.
Figure 6
Figure 6
(A) Left external carotid donor vessel is shown after temporary occlusion with arteriotomy. (B) Proximal anastomosis is made between donor artery and proximal graft using standard microanastomosis technique.
Figure 7
Figure 7
Proximal and distal ends of graft are sewn end to end completing bypass. Note proximal segment on left with Sylvian portion on right.
Figure 8
Figure 8
Temporary clips are released with bypass connected.
See this image and copyright information in PMC

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References

    1. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. N Engl J Med. 1998;339:1725–1733. [No authors listed] - PubMed
    1. Barrow D L, Alleyne C. Natural history of giant intracranial aneurysms and indications for intervention. Clin Neurosurg. 1995;42:214–244. - PubMed
    1. Lawton M T, Spetzler R F. Surgical strategies for giant intracranial aneurysms. Neurosurg Clin N Am. 1998;9:725–742. - PubMed
    1. McCormick W F, Acosta-Rua G J. The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg. 1970;33:422–427. - PubMed
    1. Orz Y, Kobayashi S, Osawa M, Tanaka Y. Aneurysm size: a prognostic factor for rupture. Br J Neurosurg. 1997;11:144–149. - PubMed