The sutureless excimer laser assisted non-occlusive anastomosis (SELANA); a feasibility study in a pressurized cadaver model

• Published in: Acta neurochirurgica 2010-09, Vol.152 (9), p.1603-1609
• Main Authors: van Doormaal, Tristan P. C., van der Zwan, Albert, Aboud, Emad, Berkelbach van der Sprenkel, Jan Willem, Tulleken, Cornelius A. F., Krisht, Ali F., Regli, Luca
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical - instrumentation; Anastomosis, Surgical - methods; Animals; Cadaver; Cerebral Revascularization - methods; Cerebrovascular Disorders - pathology; Cerebrovascular Disorders - physiopathology; Cerebrovascular Disorders - surgery; Experimental Research; Feasibility Studies; Humans; Interventional Radiology; Lasers, Excimer - therapeutic use; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Models, Anatomic; Models, Neurological; Neurology; Neuroradiology; Neurosurgery; Rabbits; Surgical Orthopedics; Vascular Surgical Procedures - instrumentation; Vascular Surgical Procedures - methods
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-010-0717-3

Objective To compare intracranial feasibility of the conventional Excimer laser assisted non-occlusive anastomosis (ELANA) with the new experimental sutureless ELANA (SELANA). Methods Four pressurized human cadaver heads were bilaterally trepanated, using a combined pterional/pretemporal/transcavernous approach. In each head, seven ELANA anastomoses and seven contralateral SELANA anastomoses were constructed on (1) the proximal PCA/basilar artery (P1 segment/basilar artery; BA), (2) the distal posterior cerebral artery (PCA, P2 segment), (3) the supraclinoidal internal carotid artery (ICA), (4) the ICA bifurcation, (5) the proximal anterior cerebral artery (ACA, A1 segment), (6) the proximal middle cerebral artery (MCA, M1 segment), and (7) the distal MCA (M2 segment). Results In total, 26 of 28 ELANA anastomoses (93%) and 22 of 28 SELANA anastomoses (79%) could be completed. Two ELANA anastomoses on the BA could not be finished because of limited space. Six SELANA anastomoses could not be attached because the applicator did not facilitate an angulated anastomosis spot. Of the remaining anastomoses, more ELANA (eight) than SELANA (two) anastomoses could not be realized without manipulation of surrounding structures. The SELANA anastomoses were completed significantly faster than the ELANA, mean difference ranging from 11 min on the M2 to 107 min on the P1/BA. Conclusion This comparative study shows potential advantages of the SELANA anastomosis over the ELANA anastomosis because during application, it causes less manipulation of surrounding structures while it is faster and easier. Further preclinical research should be performed in order to improve SELANA feasibility on angulated anastomosis spots and to assess long-term SELANA patency and endothelialization.