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de Boer B, van Doormaal TPC, Tulleken CAF, Regli L, van der Zwan A. Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model. Acta Neurochir (Wien) 2021; 163:573-581. [PMID: 32880068 PMCID: PMC7815588 DOI: 10.1007/s00701-020-04533-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND High flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. Temporary occlusion of a recipient artery in these patients could result in debilitating neurological deficits. We developed a sutureless, mechanical anastomotic connection device, the SELANA clip (Sutureless Excimer Laser-Assisted Non-occlusive Anastomosis clip: SEcl). In the present study, we aim to determine the long-term non-inferiority of the SEcl technique compared with historical data of the conventional ELANA anastomosis technique. METHODS A total of 18 SEcl bypasses were created on the carotid artery in a porcine model in 6 different survival groups. Mean application times, flap retrieval rates, hemostasis, patency, flow, endothelialization, and remodeling were assessed. RESULTS The mean application time of the SEcl anastomoses was 15.2 ± 9.6 min, which was faster compared with the conventional ELANA anastomoses. The flap retrieval rate of the SEcl anastomoses was 86% (32/37). Direct hemostasis was achieved in 89% (33/37) SEcl anastomoses. Patency in all surviving animals was 94% (17/18). Bypass flow after six months was 156.5 ± 24.7 mL/min. Full endothelialization of the SEcl pins was observed after 3 weeks. CONCLUSION The SEcl technique is not inferior to the ELANA technique regarding patency, flap retrieval rate, flow, and endothelialization. On the basis of a significantly shorter application time and superior hemostasis, the SEcl technique could be preferable over the ELANA technique. A pilot study in patients is a logical next step based on our current results.
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Affiliation(s)
- B de Boer
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G.03.124, 3584 CX, Utrecht, The Netherlands.
- Brain Technology Institute, Utrecht, The Netherlands.
| | - T P C van Doormaal
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G.03.124, 3584 CX, Utrecht, The Netherlands
- Brain Technology Institute, Utrecht, The Netherlands
- Department of Neurosurgery, Universitätsspital Zürich, Zurich, Switzerland
| | | | - L Regli
- Department of Neurosurgery, Universitätsspital Zürich, Zurich, Switzerland
| | - A van der Zwan
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G.03.124, 3584 CX, Utrecht, The Netherlands
- Brain Technology Institute, Utrecht, The Netherlands
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Lukyanchikov VA, Orlov EA, Oganesyan MV, Gordeeva AA, Pavliv MP. [Anatomical bases of brain revascularization: choosing an extra-intracranial bypass option]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:120-126. [PMID: 34951769 DOI: 10.17116/neiro202185061120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Surgical brain revascularization is an important treatment for acute or chronic ischemia, intracranial aneurysms and skull base tumors. Individual anatomy of brain vessels should be clearly understood for this procedure. Variants of collateral cerebral blood flow in patients with cerebrovascular diseases depend on individual characteristics of circle of Willis and reserve mechanisms of collateral circulation. These anatomical variations require careful preoperative planning to choose the optimal revascularization option.
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Affiliation(s)
- V A Lukyanchikov
- University's Hospital of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Russian People's Friendship University, Moscow, Russia
| | - E A Orlov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M V Oganesyan
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Gordeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M P Pavliv
- Sechenov First Moscow State Medical University, Moscow, Russia
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de Boer B, van Doormaal TPC, Stecher D, Redegeld S, Tulleken CAF, Regli L, van der Zwan A. Feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a rabbit model. Acta Neurochir (Wien) 2020; 162:175-179. [PMID: 31748901 DOI: 10.1007/s00701-019-04105-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The excimer laser-assisted non-occlusive anastomosis (ELANA) technique facilitates the construction of anastomoses without temporary occlusion of the recipient artery. Experiments aimed at simplifying the technique eventually resulted in a sutureless ELANA slide (SEsl) anastomosis. After the first clinical use, new insights lead to the application of a clip at the back of the device, the SELANA clip (SEcl). The SEcl offers a distinct advantage over the SEsl since no sealant is necessary. In this study, we determine the feasibility of the SEcl anastomosis in an in vivo rabbit model. METHODS 15 SEcl anastomoses and 15 conventional ELANA anastomoses were created on the abdominal aorta in 5 rabbits. Mean application times, flap retrieval rates, hemostasis, and burst pressures were assessed. RESULTS The mean application time of the SEcl anastomoses was 11.4 min versus 39.0 min for the ELANA anastomoses (mean difference, 27.6 min; 95% CI, 20.6-34.7). The flap retrieval rate of the SEcl anastomoses (14/15) was not inferior to the flap retrieval rate of the ELANA anastomoses (13/15). Direct hemostasis was achieved in 13/15 (87%) SEcl anastomoses and in 14/15 (94%) ELANA anastomoses. All SEcl anastomoses were resistant to provoked pressures until 250 mmHg. CONCLUSION The SEcl anastomosis is technically feasible in in vivo experiments. Mean application time, flap retrieval rate, hemostasis, and burst pressure are not inferior to the conventional ELANA anastomosis. Further long term experiments should be performed to assess safety, patency, and reendothelialization.
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Affiliation(s)
- B de Boer
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G03.124, 3584, CX, Utrecht, The Netherlands.
- Brain Technology Institute, Utrecht, The Netherlands.
| | - T P C van Doormaal
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G03.124, 3584, CX, Utrecht, The Netherlands
- Brain Technology Institute, Utrecht, The Netherlands
- Department of Neurosurgery, Universitätsspital Zürich, Zürich, Switzerland
| | - D Stecher
- Department of Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - S Redegeld
- Brain Technology Institute, Utrecht, The Netherlands
| | | | - L Regli
- Department of Neurosurgery, Universitätsspital Zürich, Zürich, Switzerland
| | - A van der Zwan
- Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G03.124, 3584, CX, Utrecht, The Netherlands
- Brain Technology Institute, Utrecht, The Netherlands
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van Doormaal TPC, de Boer B, Redegeld S, van Thoor S, Tulleken CAF, van der Zwan A. Preclinical success but clinical failure of the sutureless excimer laser-assisted non-occlusive anastomosis (SELANA) slide. Acta Neurochir (Wien) 2018; 160:2159-2167. [PMID: 30276547 PMCID: PMC6209005 DOI: 10.1007/s00701-018-3686-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/20/2018] [Indexed: 11/06/2022]
Abstract
Background The excimer laser-assisted non-occlusive anastomosis (ELANA) has been developed for intracranial bypass without the need for temporary recipient occlusion. We designed and tested a sutureless variant of the ELANA—the SELANA slide (SEsl). Objective This study aims to evaluate the SEsl preclinical results and describe its first clinical application. Methods First, in a cadaver study, 28 SEsl anastomoses were compared with 28 ELANA anastomoses. Second, in an acute rabbit model, 90 SEsl anastomoses were compared with 30 ELANA anastomoses. Finally, in a surviving pig model, 38 SEsl bypasses were created. To evaluate the clinical efficacy of the SEsl, we then treated one patient with a giant, right-sided middle cerebral artery (MCA) aneurysm with an intracranial–intracranial SEsl bypass and parent vessel occlusion. Results In preclinical studies, the SEsl anastomosis was shown to be equivalent or superior to the ELANA in terms of associated ease, patency, and bleeding complications. However, clinical application in rigid and arteriosclerotic receiving arteries was problematic. Although bypass creation and aneurysm occlusion were technically successful and the patient was postoperatively well, a pseudoaneurysm formed postoperatively at the internal carotid artery anastomosis and bled. Subsequent treatment failed and the patient did not survive. Conclusion The SEsl showed promising preclinical results across three models. However, in its present form, it is not suitable for clinical application. Trial number IRB UMCU 10/154.
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Willaert W, Tozzi F, Van Herzeele I, D’Herde K, Pattyn P. Systematic review of surgical training on reperfused human cadavers. Acta Chir Belg 2018; 118:141-151. [PMID: 29653497 DOI: 10.1080/00015458.2017.1407099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The role of reperfused human cadavers in surgical training has not been established. METHODS Reports describing reperfused human cadaver models in terms of simulated surgeries, the use of tools to assess technical competency and skills transfer to patients, cadaver status and reperfusion techniques were included. RESULTS Thirty-five reports were included. Most participants practised vascular (n = 27), flap (n = 6) and trauma (n = 4) procedures. Training progression was evaluated objectively in only two studies. In two publications, flap techniques were practised on cadavers and repeated successfully in patients. Eighteen studies employed whole bodies. Fresh and embalmed cadavers were both used in 17 publications. Most embalmed cadavers were formalin-fixed (n = 10), resulting in stiffness. Few trainings were offered on soft Thiel-embalmed cadavers (n = 5). Only arteries were reperfused in 20 studies, while in 13 publications, the arteries and veins were filled. Arteries and/or veins were mostly pressurized (n = 21) and arterial flow was generated in 14 studies. CONCLUSIONS Various reperfused human cadaver models exist, enabling practise of mainly vascular procedures. Preservation method determines the level of simulation fidelity. Thorough evaluation of these models as surgical training tools and transfer effectiveness is still lacking.
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Affiliation(s)
- Wouter Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Francesca Tozzi
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katharina D’Herde
- Department of Basic Medical Sciences, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
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Dubovoy AV, Ovsyannikov KS, Guzhin VE, Cherepanov AV, Galaktionov DM, Perfil'ev AM, Sosnov AO. [The use of high-flow extracranial-intracranial artery bypass in pathology of the cerebral and brachiocephalic arteries: technical features and surgical outcomes]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 81:5-21. [PMID: 28524121 DOI: 10.17116/neiro20178125-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor outcomes of surgical treatment for complex cerebral aneurysms due to the development of cerebral ischemia were the cause to use cerebral revascularization surgery for this pathology. OBJECTIVE the study objective was to master a high-flow extracranial-intracranial (EC-IC) artery bypass technique and evaluate its application in surgical treatment of complex and giant cerebral aneurysms as well as complex lesions of the brachiocephalic arteries. MATERIAL AND METHODS Fifty two patients underwent high-flow IC-EC bypass surgery; of these, 34 patients had complex cerebral aneurysms, and 18 patients had complex stenotic occlusive lesions of the brachiocephalic arteries. After bypass placement, the patients with aneurysms underwent different variants of aneurysm exclusion (trapping or proximal clipping/ligation of the parent artery). All patients underwent follow-up studies of the bypass function and clinical condition in the early postoperative period and 6 and 12 months after surgery. RESULTS High-flow IC-EC bypass surgery is routinely used in clinical practice of the Novosibirsk Federal Center of Neurosurgery. Fifty one out of the 52 patients were followed-up in a range of 4 to 56 months. According to the direct or CT angiography data, bypasses functioned in 51 (98.1%) patients in the early and long-term postoperative periods. The clinical efficacy (no ischemic changes and improved cerebral perfusion) of high-flow IC-EC bypasses was demonstrated in 31 (91.2%) of 34 patients with aneurysms and in 17 (94.4%) of 18 patients with complex lesions of the brachiocephalic arteries. The total number of surgical complications was 8 (15.4%) cases: 7 complications occurred in patients with aneurysms, and 1 complication developed in a patient with bilateral ICA occlusion. Of these, ischemic complications developed in 4 (7.7%) cases, hemorrhagic complications occurred in 2 (3.8%) cases, and cranial nerve complications were found in 2 (3.8%) cases. One (1.9%) female patient with a giant aneurysm died from hemispheric stroke due to insufficient blood flow through the bypass. CONCLUSION Implementation of a large number of surgeries enabled improvement of the technique and clarification of the prerequisites for preoperative examination, intraoperative control, and postoperative management of patients. A low mortalits rate suggests this technique for use in clinical practice. The surgery is indicated for the treatment of giant aneurysms of the petrous, cavernous, and clinoid segments of the ICA. In the case of giant supraclinoid aneurysms, the surgery may be combined with removal of thrombotic masses from the aneurysm sac for rapid decompression of the cranial nerves. Application of this surgery for treatment of giant aneurysms of the trunk and bifurcation of the basilar artery is promising but requires further investigation. The surgery is also recommended for improving cerebral perfusion in the setting of complex stenotic occlusive lesions of the BCA: prolonged BCA stenoses, tandem ICA stenoses located in both the extracranial and intracranial segments, nonspecific vasculitis and arteriitis, subcranial aneurysms, kinking etc.
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Affiliation(s)
- A V Dubovoy
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | | | - V E Guzhin
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | | | | | | | - A O Sosnov
- Federal Center of Neurosurgery, Novosibirsk, Russia
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Belykh E, Yagmurlu K, Martirosyan NL, Lei T, Izadyyazdanabadi M, Malik KM, Byvaltsev VA, Nakaji P, Preul MC. Laser application in neurosurgery. Surg Neurol Int 2017; 8:274. [PMID: 29204309 PMCID: PMC5691557 DOI: 10.4103/sni.sni_489_16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/18/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Technological innovations based on light amplification created by stimulated emission of radiation (LASER) have been used extensively in the field of neurosurgery. METHODS We reviewed the medical literature to identify current laser-based technological applications for surgical, diagnostic, and therapeutic uses in neurosurgery. RESULTS Surgical applications of laser technology reported in the literature include percutaneous laser ablation of brain tissue, the use of surgical lasers in open and endoscopic cranial surgeries, laser-assisted microanastomosis, and photodynamic therapy for brain tumors. Laser systems are also used for intervertebral disk degeneration treatment, therapeutic applications of laser energy for transcranial laser therapy and nerve regeneration, and novel diagnostic laser-based technologies (e.g., laser scanning endomicroscopy and Raman spectroscopy) that are used for interrogation of pathological tissue. CONCLUSION Despite controversy over the use of lasers for treatment, the surgical application of lasers for minimally invasive procedures shows promising results and merits further investigation. Laser-based microscopy imaging devices have been developed and miniaturized to be used intraoperatively for rapid pathological diagnosis. The multitude of ways that lasers are used in neurosurgery and in related neuroclinical situations is a testament to the technological advancements and practicality of laser science.
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Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nikolay L. Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ting Lei
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohammadhassan Izadyyazdanabadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Kashif M. Malik
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Vadim A. Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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van Doormaal TPC, Diederen SJH, van der Zwan A, Berkelbach JW, Kropveld A, Depauw PRAM. Simulating Internal Carotid Artery Injury during Transsphenoidal Transclival Endoscopic Surgery in a Perfused Cadaver Model. J Neurol Surg B Skull Base 2017; 79:161-166. [PMID: 29868321 DOI: 10.1055/s-0037-1605594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022] Open
Abstract
Introduction Managing internal carotid artery (ICA) injury during extended endoscopic transsphenoidal surgery is an extreme challenge. We aimed to find a possible surgical treatment strategy. Methods We operated seven fresh, perfused cadaver heads with a transsphenoidal endoscopic approach of the ICA using a three-dimensional-high definition (3D-HD) endoscope. We made a paraclival ICA leak, which we tried to manage with clips and microsutures. Results Accurate transsphenoidal clip application on the ICA was impossible with standard aneurysm clips and applier. It was only feasible with a 9 mm slightly bended clip that could be opened from the inside and be applied with a dedicated flexible thin applier. Transsphenoidal suturing of an ICA leak was impossible from the ipsilateral nostril or with standard microinstruments. Suturing was only feasible from the contralateral nostril using flexible microinstruments with a thin 90-mm shaft. This was technically very challenging and involved a steep learning curve. Conclusion Tamponade with muscle or fat and a quick transfer to the angiography suite for endovascular control remains the preferable option in case of an ICA leak during endoscopic transsphenoidal surgery. If tamponade gives insufficient initial control, ICA clipping could be possible with dedicated instruments, with risk of increasing the defect, stenosis, or occlusion of the vessel. Transsphenoidal ICA suturing remains extremely difficult, and laboratory practice seems essential.
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Affiliation(s)
- Tristan P C van Doormaal
- Department of Neurosurgery, University Medical Center Utrecht, Brain Center Rudolph Magnus, Utrecht, The Netherlands.,Brain Technology Institute, Utrecht, The Netherlands
| | - Sander J H Diederen
- Department of Neurosurgery, University Medical Center Utrecht, Brain Center Rudolph Magnus, Utrecht, The Netherlands.,Brain Technology Institute, Utrecht, The Netherlands
| | - Albert van der Zwan
- Department of Neurosurgery, University Medical Center Utrecht, Brain Center Rudolph Magnus, Utrecht, The Netherlands.,Brain Technology Institute, Utrecht, The Netherlands
| | - Jan Willem Berkelbach
- Department of Neurosurgery, University Medical Center Utrecht, Brain Center Rudolph Magnus, Utrecht, The Netherlands
| | - Arvid Kropveld
- Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Paul R A M Depauw
- Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
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Novel Application of Postmortem CT Angiography for Evaluation of the Intracranial Vascular Anatomy in Cadaver Heads. AJR Am J Roentgenol 2015; 205:1276-80. [DOI: 10.2214/ajr.15.14500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Aboud E, Aboud G, Al-Mefty O, Aboud T, Rammos S, Abolfotoh M, Hsu SPC, Koga S, Arthur A, Krisht A. "Live cadavers" for training in the management of intraoperative aneurysmal rupture. J Neurosurg 2015; 123:1339-46. [PMID: 26140492 DOI: 10.3171/2014.12.jns141551] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intraoperative rupture occurs in approximately 9.2% of all cranial aneurysm surgeries. This event is not merely a surgical complication, it is also a real surgical crisis that requires swift and decisive action. Neurosurgical residents may have little exposure to this event, but they may face it in their practice. Laboratory training would be invaluable for developing competency in addressing this crisis. In this study, the authors present the "live cadaver" model, which allows repetitive training under lifelike conditions for residents and other trainees to practice managing this crisis. METHODS The authors have used the live cadaver model in 13 training courses from 2009 to 2014 to train residents and neurosurgeons in the management of intraoperative aneurysmal rupture. Twenty-three cadaveric head specimens harboring 57 artificial and 2 real aneurysms were used in these courses. Specimens were specially prepared for this technique and connected to a pump that sent artificial blood into the vessels. This setting created a lifelike situation in the cadaver that simulates live surgery in terms of bleeding, pulsation, and softness of tissue. RESULTS A total of 203 neurosurgical residents and 89 neurosurgeons and faculty members have practiced and experienced the live cadaver model. Clipping of the aneurysm and management of an intraoperative rupture was first demonstrated by an instructor. Then, trainees worked for 20- to 30-minute sessions each, during which they practiced clipping and reconstruction techniques and managed intraoperative ruptures. Ninety-one of the participants (27 faculty members and 64 participants) completed a questionnaire to rate their personal experience with the model. Most either agreed or strongly agreed that the model was a valid simulation of the conditions of live surgery on cerebral aneurysms and represents a realistic simulation of aneurysmal clipping and intraoperative rupture. Actual performance improvement with this model will require detailed measurement for validating its effectiveness. The model lends itself to evaluation using precise performance measurements. CONCLUSIONS The live cadaver model presents a useful simulation of the conditions of live surgery for clipping cerebral aneurysms and managing intraoperative rupture. This model provides a means of practice and promotes team management of intraoperative cerebrovascular critical events. Precise metric measurement for evaluation of training performance improvement can be applied.
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Affiliation(s)
- Emad Aboud
- Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas
| | - Ghaith Aboud
- Atlantic University, School of Medicine, Island Park, New York
| | - Ossama Al-Mefty
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Talal Aboud
- Atlantic University, School of Medicine, Island Park, New York
| | - Stylianos Rammos
- Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas
| | - Mohammad Abolfotoh
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;,Department of Neurosurgery, Ain Sham University, Cairo, Egypt
| | - Sanford P C Hsu
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Sebastian Koga
- International Neuroscience Institute, Hannover, Germany; and
| | - Adam Arthur
- Semmes-Murphey Neurologic and Spine Institute, and Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Ali Krisht
- Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas
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Sia SF, Morgan MK. High flow extracranial-to-intracranial brain bypass surgery. J Clin Neurosci 2013; 20:1-5. [PMID: 23084349 DOI: 10.1016/j.jocn.2012.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/05/2012] [Indexed: 10/27/2022]
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12
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van Doormaal TPC, van der Zwan A, Redegeld S, Verweij BH, Tulleken CAF, Regli L. Patency, flow, and endothelialization of the sutureless Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique in a pig model. J Neurosurg 2011; 115:1221-30. [PMID: 21780856 DOI: 10.3171/2011.6.jns101491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to assess flow, patency, and endothelialization of bypasses created with the sutureless Excimer Laser Assisted Non-occlusive Anastomosis (SELANA) technique in a pig model. METHODS In 38 pigs, a bypass was made on the left common carotid artery (CCA), using the right CCA as a graft, with 2 SELANAs. Bypass flow was measured using single-vessel flowmetry. The pigs were randomly assigned to 1 of 12 survival groups (1, 2, 3, 4, 5, 6, 7, and 10 days; 2 and 3 weeks; and 3 and 6 months). One extra animal underwent the procedure and then was killed after 1 hour of bypass patency to serve as a control. Angiography was performed just before the animals were killed, to assess bypass patency. Scanning electron microscopy and histological studies were used to evaluate the anastomoses after planned death. RESULTS The mean SELANA bypass flow was not significantly different from the mean flow in the earlier ELANA (Excimer Laser Assisted Non-occlusive Anastomosis) pig study at opening and follow-up. Overall SELANA bypass patency (87%) was not significantly different from the ELANA patency of 86% in the earlier study. Complete SELANA endothelialization was observed after 2-3 weeks, compared with 2 weeks in the earlier ELANA study. CONCLUSIONS The SELANA technique is not inferior to the current ELANA technique regarding flow, patency, and endothelialization. A pilot study in patients is a logical next step.
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Affiliation(s)
- Tristan P C van Doormaal
- Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
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Vajkoczy P, Korja M, Czabanka M, Schneider UC, Reinert M, Lehecka M, Schmiedek P, Hernesniemi J, Kivipelto L. Experience in Using the Excimer Laser–Assisted Nonocclusive Anastomosis Nonocclusive Bypass Technique for High-Flow Revascularization. Neurosurgery 2011; 70:49-54; discussion 54-5. [DOI: 10.1227/neu.0b013e31822cb979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
The excimer laser–assisted nonocclusive anastomosis (ELANA) technique enables large-caliber bypass revascularization without temporary occlusion of the parent artery.
OBJECTIVE
To present the surgical experience of 2 bypass centers using ELANA in the treatment of complex intracranial lesions.
METHODS
Between July 2002 and December 2007, 64 consecutive patients (37 in Germany and 27 in Finland) were selected for high-flow bypass surgery with ELANA. Modified Rankin Scale, a bypass success rate, and the success rate of the laser arteriotomy were assessed.
RESULTS
In 66 surgeries for 64 intent-to-treat patients, 58 ELANA procedures were completed successfully. A favorable outcome (postoperative modified Rankin Scale score less than or equal to preoperative modified Rankin Scale) at 3 months was achieved in 43 of 56 patients (77%) with anterior circulation lesions (37 of the 43 patients had aneurysms, 4 had ischemia, and 2 received a bypass before tumor removal) and only in 2 of 8 patients (25%) with posterior circulation aneurysms. Perioperative (< 7 days) mortality for anterior and posterior circulation aneurysms was 6% and 50%, respectively. At the 3-month follow-up, 12% and 63% of patients with anterior and posterior circulation aneurysms, respectively, were dead. The success rate of the laser arteriotomy was 70%. Another 14% were retrieved manually after a nearly complete laser arteriotomy.
CONCLUSION
The ELANA procedure requires a meticulous and careful operative technique. Morbidity and especially mortality rates, usually unrelated to ELANA, are comparable to those of contemporary series of conventional high-flow revascularization operations. This underscores the overall complexity of treating neurovascular pathologies by high-flow bypasses.
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Affiliation(s)
- Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Miikka Korja
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Marcus Czabanka
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Ulf C. Schneider
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Michael Reinert
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Peter Schmiedek
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Leena Kivipelto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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