In a recent report (‘Neurosurgery’, van Doormaal et al, October 2006) is shown that it was possible to create a patent high flow Extra- Intracranial ELANA bypass in 93% of 34 patients with a giant internal carotid artery (ICA) aneurysm treated in the UMC Utrecht (Figure 1). Mean flow was 124 cc/ min. Of these patients 74% had a long term (mean 3.3 years) favorable outcome (defined as independent and the same or a better functionality as preoperative). Recent research (accepted for publication in ‘Neurosurgery’, van Doormaal et al) shows that in 91% of patients with a giant middle cerebral artery (MCA) aneurysm it was possible to create a patent bypass (92% Intra- Intracranial bypasses, mean flow 56 cc/min) (Figure 2). At long term follow up (mean 3.6 years), 77% of these patients had a favorable outcome.
Figure 1: A giant ICA aneurysm (red arrow, lef angiogramt) is bypassed with a Ec-Ic bypass with a proximal anastomosis on the ECA and a distal ELANA anastomosis on the ICA bifurcation (green arrow, middle and right angiogram). Postoperatively, the ICA was occluded with a detachable balloon (blue arrow, right angiogram). Patient recovered perfectly.
Figure 2: Giant right sided MCA aneurysm (left angiogram). Ic-Ic bypass with a proximal ELANA anastomosis (red arrow) and a distal conventional anastomosis (right angiogram). The aneurysm was trapped (proximal and distal aneurysm clip on the MCA) during the same procedure. Patient recovered with maximum functional health (mRankin 0)
Figure 3: Giant left sided MCA aneurysm (Left and middle angiogram). IC-IC bypass with proximal and distal ELANA anastomosis (red arrows). Aneurysm was trapped, patient recovered without any morbidity(mRankin 0)
Also giant aneurysm of the Anterior Cerebral Artery, the Anterior Communicating artery, and even the basilar and vertebral artery were treated with an ELANA bypass. These are very challenging procedures in which ELANA has been proven to be a valuable addition to the treatment armamentarium of the vascular neurosurgeon. For more questions about this topic please refer to Dr B. van der Zwan or Prof. dr C.A.F. Tulleken, please use the following link: Contact