Artikel
Excimer Laser-assisted high-flow bypass surgery for the treatment of complex aneurysms
Excimer Laser assistierte High-flow Bypasschirurgie in der Behandlung komplexer Aneurysmen der vorderen Zirkulation
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Autoren
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P. Vajkoczy
- Neurochirurgische Klinik, Universitätsklinikum Mannheim
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T. Kinfe
- Neurochirurgische Klinik, Universitätsklinikum Mannheim
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J. Woitzik
- Neurochirurgische Klinik, Universitätsklinikum Mannheim
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P. Schmiedek
- Neurochirurgische Klinik, Universitätsklinikum Mannheim
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Extracranial/intracranial high-flow bypass surgery carries a significant perioperative risk for ischemia due to temporary occlusion of the receipient vessel. In order to circumvent the need for temporary vessel occlusion, Tulleken and coworkers have developed the Excimer Laser-assisted non-occlusive anastomosis (ELANA) technique which has been established in our institution in 2002. The aim of this study was to review our initial experience with the ELANA technique in high-flow bypass surgery.
Methods
Between 8/2002 and 11/2004, we have treated 20 patients (age 24-74 yrs) with complex anterior circulation aneurysms or skull base tumors who failed the balloon occlusion test with differential revascularization techniques and parent vessel occlusion. In 13 patients (n=11 ICA-aneurysms, n=1 M1-aneurysm, n=1 clivus chordoma) saphenous vein high-flow bypass surgery was performed using the ELANA technique. Bypass patency was confirmed intraoperatively by doppler flow measurements and/or fluorescence angiography and proximal vessel occlusion was performed subsequently. Patients received ASS intra- and postoperatively. Postoperative imaging included CT/MRI and conventional angiography.
Results
Different types of high-flow bypasses were created based on aneurysm location and vascular anatomy. They comprised 11 extracranial/intracranial (CCA-to-C4 (n=1), ECA-to-C4 (n=6), ECA-to-M1 (n=1), ECA-to-M2 (n=1)) and 2 intracranial/intracranial (C4-to-M1 (n=1), C4-to-M2 (n=1)) bypasses. In all cases, use of the ELANA technique resulted in adequate anastomoses and functioning bypasses (short term patency rate 100%, mean graft flow 109 ± 43 ml/min). ELANA technique-related complications were not observed. However, postoperatively, 1 patient sustained a partial MCA infarction (GOS 3) and 1 patient died (GOS 1) due to global brain edema of unknown origin, in both cases despite a patent bypass. The other 11 patients were discharged at GOS 5.
Conclusions
Our initial experience confirms that the ELANA technique represents a safe and elegant technique that facilitates high-flow bypass surgery and may reduce the risk of perioperative ischemia.
