Crocker Matthew, Walsh Daniel, Epaliyanage Prasanna, Tolias Christos M
Department of Neurosurgery, King's College Hospital, London, UK.
Br J Neurosurg. 2010 Apr;24(2):148-55. doi: 10.3109/02688690903506127.
The Excimer Laser Assisted Non-occlusive cerebral vascular Anastomosis (ELANA) has been proposed as a major advance in the field of cerebral revascularisation. Appreciable challenges remain, however. We report our experience with introducing this technique to the UK and review the field of cerebral revascularisation and flow replacement. Retrospective review of prospectively recorded case series. Data were collected prospectively, complication data were recorded and analyzed and functional surgical outcomes were measured using the modified Rankin scale (MRS). Ten patients, during a 2-year period, were considered suitable for high-flow cerebrovascular bypass surgery, with 8 proceeding to surgery. Seven bypasses were completed and 1 abandoned. Of the 5 patients neurologically intact preoperatively, 3 remained so postoperatively, 4 experienced no neurological deficit and one suffered transient hemiparesis due to hyperperfusion which resolved. One patient with preoperative hemiparesis improved. One patient died 8 days postoperatively. Overall long-term patency rate was (42%), however 3 thrombosed bypasses were all competitive (used for prophylactic intraoperative reasons), 2 thrombosing after the surgical procedure was completed. We discuss the role for this modern technique and the lessons learnt from its introduction to the UK, and consider the current and future requirements for cerebral revascularisation.
准分子激光辅助非闭塞性脑血管吻合术（ELANA）已被视为脑血管重建领域的一项重大进展。然而，仍存在诸多显著挑战。我们报告了将该技术引入英国的经验，并回顾了脑血管重建和血流置换领域的情况。对前瞻性记录的病例系列进行回顾性分析。前瞻性收集数据，记录并分析并发症数据，使用改良Rankin量表（MRS）衡量手术功能结局。在两年期间，10例患者被认为适合进行高流量脑血管搭桥手术，其中8例进行了手术。完成了7例搭桥手术，1例放弃。术前神经功能完好的5例患者中，3例术后仍保持如此，4例无神经功能缺损，1例因高灌注出现短暂性偏瘫，随后恢复。1例术前偏瘫患者有所改善。1例患者术后8天死亡。总体长期通畅率为（42%），然而，3例搭桥血管血栓形成均为竞争性的（因术中预防性使用），2例在手术完成后出现血栓形成。我们讨论了这项现代技术的作用以及从其引入英国所吸取的经验教训，并考虑了当前和未来脑血管重建的需求。
