gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Experience with the ELANA non occlusive bypass technique for high-flow revascularizatrion in 56 patients

Meeting Abstract

  • Ulf C. Schneider - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Neurochirurgische Klinik, Universitätsklinikum Mannheim, Deutschland
  • Miikka Korja - Department of Neurosugery, Helsinki University Central Hospital, Helsinki, Finland
  • Marcus Czabanka - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Neurochirurgische Klinik, Universitätsklinikum Mannheim, Deutschland
  • Martin Lehecka - Department of Neurosugery, Helsinki University Central Hospital, Helsinki, Finland
  • Lena Kivipelto - Department of Neurosugery, Helsinki University Central Hospital, Helsinki, Finland
  • Peter Vajkoczy - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Neurochirurgische Klinik, Universitätsklinikum Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1526

DOI: 10.3205/10dgnc003, URN: urn:nbn:de:0183-10dgnc0038

Published: September 16, 2010

© 2010 Schneider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: To present the surgical experience of two national bypass centers in Germany and Finland using the Excimer Laser Assisted Nonocclusive Anastomosis (ELANA) technique in the treatment of complex intracranial lesions via revascularization strategies.

Methods: Between 2002 and 2007, 56 consecutive patients (Germany 37, Helsinki 27) were elected for high-flow bypass surgery using the ELANA technique. In these 56 patients, a total of 59 ELANA bypass procedures was intended (intent-to-treat population). Surgical outcome (modified Rankin Scale), bypass patency rate and the success rate of the laser arteriotomy were assessed.

Results: 52 ELANA procedures within the intent-to-treat population of 59 surgeries (88%), could be successfully completed. Angiographic assessment on days 7–9 revealed a short-term patency rate of 96%. A favorable outcome (mRS) was achieved in 35/42 (84%) patients with anterior circulation aneurysm, 3/8 (37%) patients with posterior circulation aneurysms, 4/4 (100%) patients treated for acute ischemia, and 2/2 (100%) patients receiving a bypass prior to tumor removal. 30-days permanent morbidity and mortality rates were 9% and 13%, respectively.

Conclusions: The ELANA procedure requires a meticulous and careful operative technique. Morbidity and mortality rates are comparable to contemporary series of conventional high-flow revascularization strategies and remain considerable despite the non-occlusive nature of the ELANA technique. Nevertheless, our results clearly compare favorable with the natural histories of these patholgies as well as the results of published microsurgical and endovascular series.