title: Emergency Non-occlusive High Capacity Bypass Surgery for Ruptured Giant Internal Carotid Artery Aneurysms.
abstract: Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH).
  
  
  
  The management of two consecutive patients treated with ELANA bypass during a 6-month period (June- December 2013) for ruptured giant ICA aneurysms in an emergency setting is presented.
  
  
  
  The two patients presented with SAH and newly diagnosed giant ICA aneurysms (both Fisher 3; WFNS scores 2 and 4, respectively). Both patients received an emergent high-capacity extra- to intracranial (EC-IC) bypass with interposition of a saphenous vein graft between the external carotid artery (ECA) and the ICA-termination. The intracranial anastomosis was performed by the use of the non-occlusive ELANA technique. The aneurysms were successfully trapped, and there were no major complications and no major persistent morbidity in either patient. A good clinical outcome was obtained with a modified Rankin scale of 2 at the last follow-up in both patients.
  
  
  
  Emergency ELANA bypass surgery is a useful instrument for managing patients with giant ICA aneurysms presenting with SAH. In experienced hands, the technique does not seem to carry increased risk and may expand the surgical options due to its non-occlusive nature.
authors.affiliation: Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland. Jan-Karl.Burkhardt@usz.ch.|Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, Zürich, 8091, Switzerland. Jan-Karl.Burkhardt@usz.ch.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Neurosurgery, University Hospital Zürich, Zürich, CH-8091, Switzerland.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Department of Neurosurgery, University Hospital Zürich, Zürich, CH-8091, Switzerland.
authors.forename: Jorn
authors.initials: J
authors.lastname: Fierstra
authors.affiliation: Department of Neurosurgery, University Hospital Zürich, Zürich, CH-8091, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
authors.affiliation: Department of Neurosurgery, University Hospital Zürich, Zürich, CH-8091, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D000072226:Computed Tomography Angiography; D004630:Emergencies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Emergency bypass; Excimer laser-assisted non-occlusive anastomosis (ELANA); Giant aneurysm, ruptured aneurysm, complex aneurysm; Subarachnoid hemorrhage