title: The sutureless excimer laser assisted non-occlusive anastomosis (SELANA); a feasibility study in a pressurized cadaver model.
abstract: 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.
authors.affiliation: 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
authors.forename: Tristan P C
authors.initials: TP
authors.lastname: van Doormaal
authors.forename: Albert
authors.initials: A
authors.lastname: van der Zwan
authors.forename: Emad
authors.initials: E
authors.lastname: Aboud
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Berkelbach van der Sprenkel
authors.forename: Cornelius A F
authors.initials: CA
authors.lastname: Tulleken
authors.forename: Ali F
authors.initials: AF
authors.lastname: Krisht
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
mesh_terms: 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