Giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis bypass.

摘要

OBJECTIVE: To define the safety and clinical value of giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis (ELANA) bypass. METHODS: We report 32 patients with an uncoilable intracerebral giant aneurysm, operated on with the aid of an ELANA protective bypass between January 1, 1994, and January 1, 2008. We retrospectively collected data from patient records. Follow-up data were updated by telephone interview. We defined a favorable outcome as a successfully treated aneurysm and a better or equal postoperative modified Rankin scale (mRS) score compared with the preoperative mRS. RESULTS: In total 33 bypasses were constructed, of which 31 (94%) were patent during the rest of the procedure. The first failed bypass was salvaged during a second procedure. Of the second failed bypass, the ELANA anastomosis could be reused during second bypass surgery. All 32 aneurysms could be treated. The bypasses served as protection during temporary parent vessel occlusion (n = 24, 75%), control during aneurysm rupture (n = 3, 9%), and in all patients as an indicator for recipient artery narrowing during clip placement. Four bypasses (12%) eventually had to partially (n = 3) or fully (n = 1) replace recipient artery flow at the end of surgery. Postoperatively, 3 patients (9%) had a hemorrhagic complication and 2 patients (6%) had an ischemic complication. At long-term follow-up (mean, 6.1 +/- 3.4 y), 28 patients (88%) had a favorable functional outcome. CONCLUSION: The ELANA protective bypass is a safe and useful instrument for the treatment of these difficult aneurysms.