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


CONCLUSIONS
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.
van Doormaal
Tristan P C
TP
Department of Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, PO box 85500, 3508 GA Utrecht, The Netherlands. T.vandoormaal@gmail.com
van der Zwan
Albert
A
Aboud
Emad
E
Berkelbach van der Sprenkel
Jan Willem
JW
Tulleken
Cornelius A F
CA
Krisht
Ali F
AF
Regli
Luca
L
D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D000818:Animals; D002102:Cadaver; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008953:Models, Anatomic; D008959:Models, Neurological; D011817:Rabbits; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods