• Albert van der Zwan, Peter Vajkoczy, Sepideh Amin-Hanjani, Fady T Charbel, Babu Welch, Michael Tymianski, Leena Kivipelto, Sander van Thoor, Shamik Chakraborty, Devon O'Donnell, and David J Langer.
• Department of Neurosurgery and Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
• Neurosurgery. 2020 Sep 15; 87 (4): 697-703.

BackgroundBoth conventional bypass utilizing temporary recipient vessel occlusion and the excimer laser-assisted nonocclusive anastomosis (ELANA) bypass technique are possible strategies in the treatment of giant aneurysms. These treatments have only been studied in single institutional retrospective studies. The potential advantage of the ELANA technique is the absence of temporary occlusion of major arteries, decreasing the risk of intraoperative ischemia.ObjectiveTo investigate the risks and potential benefits of high-flow bypass surgery for giant and complex aneurysms of the anterior cerebral circulation. In addition, the effectiveness of the ELANA bypass procedure in the treatment of these aneurysms is determined.MethodsA total of 37 patients were included in 8 vascular neurosurgical centers in the United States, Canada, and Europe. A 30-d postoperative bypass follow-up was studied by using digital subtraction angiography and/or magnetic resonance angiography and computed tomography angiography to assess patency as well as by clinical monitoring in all patients.ResultsIn 35 patients, an ELANA high-flow bypass was performed and the aneurysm treated. Four patients had remaining neurological deficits after 30 d caused by stroke (11.4%). These strokes were not related to the ELANA anastomosis device.ConclusionThis study does not prove that the ELANA technique has an advantage over conventional bypass techniques, but it appears to be an acceptable alternative to conventional transplanted high-flow bypass in this very-difficult-to-treat patient group, especially in select patients whom cannot be bypassed using conventional means in which temporary occlusion is considered to be not recommended.Copyright © 2019 by the Congress of Neurological Surgeons.

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