"How I Do It:" Non-occlusive High Flow Bypass Surgery

Giant intracranial aneurysms are a formidable challenge for treatment, considering their grim prognosis. Until lately, endovascular treatment options have been disappointing, and neurosurgical treatment results are by far the most promising. In the neurosurgical treatment of giant intracranial aneurysms, the non-occlusive nature of the ELANA anastomosis technique is a major advantage in flow replacement bypass surgery where large proximal arteries with higher flows need to be replaced or reconstructed. The construction of a deep intracranial anastomosis using the ELANA technique needs less vessel exposure than when using a conventional occlusive technique. This extra advantage facilitates the construction of anastomoses even on the ICA, MCA, ACA, P1, P2, SCA or BA, using the trans-Sylvian route only, without major skull base surgery. Several different types of EC-IC and IC-IC flow replacement bypass are now safely applicable due to the non-occlusive character of this technique.Future improvements of the technique are focused on sutureless applications, graft improvements and Flow Model Simulation. It is clear that not only conventional bypass techniques, but also, and even especially, the ELANA bypass technique, are of great value in the treatment of giant aneurysms.