De Boer B, Van Doormaal T P, Van Der Zwan A, Tulleken C A, Regli L
Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center of Utrech, Utrecht, The Netherlands.
J Neurosurg Sci. 2011 Jun;55(2):117-25.
Sutureless vascular anastomoses have been the subject of extensive research for decades. In neurosurgery the need for a safe and fast technique is high, because temporary occlusion of cerebral arteries may rapidly lead to brain ischemia. Conventional sutured anastomoses have always been the golden standard. Limited working space and difficult suturing techniques were reasons to find alternatives. Many artificial devices to create anastomoses have been engineered over the years like tissue sealants, clips and automated suturing sets with variable success. For all previous options, temporary occlusion of the recipient artery was necessary. The Excimer Laser Assisted Non-Occlusive Anastomosis (ELANA) technique™ facilitates the construction of an end-to-side anastomosis without temporary occlusion of the recipient artery using a platinum ring and a laser. However, the technical challenge of intracranial micro-sutures remained. Experiments using less sutures eventually resulted in a sutureless ELANA (SELANA) anastomosis. After in vitro and in vivo experiments, the SELANA slide was considered feasible for intracranial use although some concrete improvements, like the inclusion of a clip at the back of the device, were needed. Therefore, the development of an ideal sutureless anastomosis is still ongoing. This process is an evolution rather than a revolution.
几十年来，无缝合血管吻合术一直是广泛研究的主题。在神经外科手术中，对安全快速技术的需求很高，因为大脑动脉的临时闭塞可能会迅速导致脑缺血。传统的缝合吻合术一直是金标准。有限的工作空间和困难的缝合技术促使人们寻找替代方法。多年来，已经设计出许多用于创建吻合术的人工装置，如组织密封剂、夹子和自动缝合装置，但成功率各不相同。对于之前所有的方法，都需要临时闭塞受体动脉。准分子激光辅助非闭塞吻合术（ELANA）技术™ 借助铂环和激光，无需临时闭塞受体动脉即可完成端侧吻合术的构建。然而，颅内微缝合的技术挑战依然存在。减少缝合线使用的实验最终产生了无缝合ELANA（SELANA）吻合术。经过体外和体内实验，SELANA载玻片被认为可用于颅内，但仍需要一些具体改进，如在装置背面增加一个夹子。因此，理想的无缝合吻合术仍在不断发展。这个过程是一个渐进的演变，而非彻底的变革。
