Department of Neurosurgery, University Medical Center Utrecht, Brain Technology Institute, Utrecht, The Netherlands.
Brain Technology Institute, Utrecht, The Netherlands.
Acta Neurochir (Wien). 2022 Jul;164(7):1861-1871. doi: 10.1007/s00701-022-05182-1. Epub 2022 May 7.
The excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth. The present study investigates the clinical feasibility and safety of the SEcl technique.
Three patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed.
All aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved).
The SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.
准分子激光辅助非闭塞吻合术（ELANA）旁路技术可能具有非闭塞设计的优势，适用于血管内治疗或直接夹闭被认为不安全的最后手段病例。然而，该技术仍然具有技术挑战性。因此，开发了一种无缝线的 ELANA 夹（SEcl）装置，以简化技术，避免深度繁琐的吻合缝合。本研究旨在探讨 SEcl 技术的临床可行性和安全性。
经过多学科共识，选择了 3 例位于前循环的复杂大动脉瘤患者，这些动脉瘤由于过于复杂而不适合血管内或直接夹闭治疗。旁路手术被认为是最后的治疗选择，在术前评估和知情同意后，进行 SEcl 旁路手术。评估适用性、技术方面和患者结局。
所有动脉瘤均从循环中排除。颅内吻合的建立更容易且更快。未发生与器械相关的严重不良事件，所有结局均良好（1 例患者改良 Rankin 量表稳定，2 例患者改善）。
SEcl 吻合技术是可行的，考虑到疾病的严重程度，相对安全。对于非常难以治疗的最后手段动脉瘤病例，它可以被视为一种治疗选择。从这项研究中，开始进一步开发最小化夹尺寸并应用于心脏手术。
