Interview with Bart van der Zwan and Tristan van Doormaal
Interview with Bart van der Zwan and Tristan van Doormaal
There have been several revolutions in neurosurgery so far. Fifty years ago it was the microscope, enabling operations in the brain, neck and back. Mid nineties the ELANA Bypass procedure was invented by neurosurgeon Cees Tulleken at the UMC Utrecht: a method of creating a high flow bypass deep in the skull without temporal occlusion of the vessels (Excimer Laser Assisted Non-occlusive Anastomosis).
Preventing an aneurysm from rupturing is done by coiling (around 70 percent of the patients), clipping (around 30 percent) or creating a bypass (1 percent). The latter is an option when an aneurysm can't be safely clipped or is out of reach for a catheter. For last resort cases, the ELANA technique comes in and around 600 patients have had an ELANA bypass constructed.
Improving the ELANA technique uitklapper, klik om te openen
“Some colleagues were quite cynical about the outcome rate of patients treated with the ELANA technique: ‘Everybody dies within five years, don't they?’ To prove them wrong, we tracked all patients that had been operated on using this technique: 75 percent of these patients that were otherwise not treatable were still alive and led a better life than before surgery.” In the meantime, the ELANA team started to investigate whether the time-consuming stitching procedure of the bypass operation could be shortened.
“That part takes up to 90 minutes; it would be great for surgeons and patients to do without it. We used SELENA (the S stands for sutureless) on a patient for the first time in 2010 after a lot of work in our laboratories. The technique has improved and our current pilot study looks very promising. Beside treating large aneurysms with SELENA, an additional future application may be brain ischemia. Nowadays ELANA is used all over the world. The technique requires a lot of craftsmanship, routine and practice though – so far we have trained as many as 200 surgeons.”