Cerebral Bypass

An angiogram of a cerebral bypass

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Basiler bypass animation
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The Elana Technique, click on logo above

The Conventional Technique

A cerebral bypass is a surgical technique which involves connecting a blood vessel from outside the brain to a vessel within the brain in order to provide blood to an area of brain which either needs more blood flow or is fed by a vessel which needs to be sacrificed to treat a specific pathology. Bypasses come in essentially two types. The first type is called a superficial temporal artery to middle cerebal artery bypass or STAMCA. The superficial temporal artery (STA) normally provides blood to the face and scalp and can safely be surgically disconnected from the scalp and attached to brain vessels. You can feel the pulse of the STA in front of your ear. This bypass is utilized to provide additional flow to the brain primarily due to a loss of flow from a large vessel due to vascular disease. This operation is performed to decrease the risk of stroke in a small subset of patients. The second type of bypass utilizes a transplanted vessel such as a saphenous vein or radial artery to connect an artery in the neck to a large brain vessel. These types of bypasses provide more flow than the lower flow STAMCA and are utilized primarily when a large vessel of the brain needs to be sacrificed in order to cure an untreatable aneurysm or skull base tumor that involves a major brain vessel.

Roosevelt Hospital is due to become the only center in the United States to perform a new type of bypass called ELANA sometime between the end of 2006 to early 2007. Roosevelt will be taking a leadership role in the emergence of this new technology in the United States, and will be involved in helping to develop this technology nationwide.

The Elana Technique

ELANA: Excimer Laser-Assisted Nonocclusive Anastomosis for Extracranial to Intracranial and Intracranial to Intracranial Bypass.

ELANA, excimer laser-assisted nonocclusive anastomosis, is a technique using an excimer laser/catheter system for intracranial bypass surgery of the brain. The technique has been developed over the past 12 years by Tulleken and colleagues at UMC Utrecht in The Netherlands for treatment of primarily untreatable giant aneurysms. The emergence of transplanted conduit bypass is a valuable technique for managing these lesions and the subsequent development of ELANA bypass. The ELANA technique allows the operating surgeon to perform an extracranial-to-intracranial or intracranial-to-intracranial bypass using a transplanted large caliber conduit without occlusion of the recipient artery, thus eliminating intraoperative ischemic insult related to temporary occlusion time.

Dr. Chandranath Sen and Dr. CAF Tulleken





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