neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"neurosurgery-22Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTПервый опыт выполнения широкопросветных экстра-интракраниальных анастомозов для лечения больных с гигантскими аневризмами внутренней сонной артерииFirst experience of high-flow extra-intracranial bypasses for treatment of patient with giant aneurysms of internal carotid arteryКрыловВладимир ВикторовичKrylovV. V.noemail@neicon.ruНахабинОлег ЮрьевичNakhabinO. Ju.noemail@neicon.ruПолунинаНаталья АлексеевнаPoluninaN. A.npolunina82@yandex.ruЛукьянчиковВиктор АлександровичLukianchikovV. A.noemail@neicon.ruВинокуровАлексей ГеоргиевичVinokurovA. G.noemail@neicon.ruКуксоваНадежда СтепановнаKuksovaN. S.noemail@neicon.ruГригорьеваЕлена ВладимировнаGrigorievaE. V.noemail@neicon.ruХамидоваЛайла ТимарбековнаKhamidovaL. T.noemail@neicon.ruЕфременкоСергей ВладимировичEfremenkoS. V.noemail@neicon.ruНаучно-исследовательский институт Скорой помощи им. Н.В. СклифосовскогоRussian Federation201305102017022539Copyright © Крылов В.В., Нахабин О.Ю., Полунина Н.А., Лукьянчиков В.А., Винокуров А.Г., Куксова Н.С., Григорьева Е.В., Хамидова Л.Т., Ефременко С.В., 20172017Крылов В.В., Нахабин О.Ю., Полунина Н.А., Лукьянчиков В.А., Винокуров А.Г., Куксова Н.С., Григорьева Е.В., Хамидова Л.Т., Ефременко С.В.Krylov V.V., Nakhabin O.J., Polunina N.A., Lukianchikov V.A., Vinokurov A.G., Kuksova N.S., Grigorieva E.V., Khamidova L.T., Efremenko S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/22

Цель: представить первый опыт выполнения широкопросветных экстра-интракраниальных анастомозов (ЭИКА) по поводу гигантских аневризм (ГА) внутренней сонной артерии (ВСА). Материалы и методы: выполнено наложение ЭИКА у 4 пациенток с гигантскими аневризмами ВСА: двое больных с псевдотуморозным течением ГА кавернозного отдела ВСА, 1 пациентка со сложной ГА развилки правой ВСА со смешанным течением (апоплектиформное и псевдотуморозное) и 1 больная с ГА офтальмического сегмента левой ВСА со смешанным типом течения (эмболический и апоплектиформный). Результаты: Во всех наблюдениях в качестве аутотрансплантата использовали участок лучевой артерии. Пациентке с ГА офтальмического сегмента ВСА выполнили экстренное наложение ЭИКА между М2-сегментом левой средней мозговой артерии (СМА) и левой наружной сонной артерией (НСА) в связи с интраоперационным тромбозом супраклиноидного отдела ВСА после клипирования и иссечения аневризмы. Остальным трем пациенткам провели наложение широкопросветного ЭИКА между М2-сегментом правой СМА и правой НСА в плановом порядке с применением умеренной гипотермии, с использованием барбитуратов и ЭЭГ-мониторингом с последующей перевязкой правой ВСА на шее. Функционирование анастомоза подтверждалось при помощи интраоперационной допплерографии, при выполнении церебральной ангиографии в послеоперационном периоде и при ультразвуковом исследовании области анастомоза. У одной пациентки через неделю после операции отметили тромбоз ЭИКА в связи с развитием коллатерального кровообращения без нарастания неврологического дефицита, однако больная скончалась от тромбоэмболии легочной артерии через 3 недели после операции. У одной больной произошел тромбоз ЭИКА в первые сутки после операции с развитием обширного очага ишемии головного мозга. Две пациентки выписаны в удовлетворительном состоянии с функционирующим ЭИКА. Заключение: Наложение широкопросветного ЭИКА является одним из методов лечения гигантских аневризм ВСА. Плановое вмешательство необходимо проводить в условиях специально оснащенной операционной с ЭЭГ-мониторингом, применением барбитуратов и умеренной гипотермии. Возможно экстренное наложение широкопросветного ЭИКА в случае интраоперационного тромбоза ВСА.

Objective: to demonstrate the first experience of high-flow extra-intracranial (EC-IC) bypasses performance for treatment of patients with giant aneurysms (GA) of internal carotid artery (ICA). Material and methods: we performed high-flow EC-IC bypasses at 4 female patients with GA of ICA: two patients had GA of cavernous ICA with tumor-like (mass effect) signs, 1 patient - complex GA of ICA bifurcation with combined (apoplectiform and tumor-like) clinical manifestation and 1 patient with left ophthalmic GA also with combined clinical manifestation (embolic and apoplectiform). Results: We used radial artery as an autoshunt in all cases. Patient with left ophthalmic GA underwent urgent performance of EC-IC bypass between M2 segment of left middle cerebral artery (MCA) and left external carotid artery (ECA) because if intraoperative thrombosis of supraclinoid ICA after clipping and resection of aneurysm. The other three patients underwent routinely operation with performance of EC-IC high-flow bypass between M2 segment of right MCA and right ECA with following right ICA sacrifice with the usage of moderate hypothermia and barbiturates as well as EEG-monitoring. The bypass patency confirmed by intraoperative Doppler sonography, digital subtraction angiography in postoperative period and by ultrasound examination of subcutaneous bypass region. One patient underwent the bypass thrombosis without any neurological deficit in one week after operation because of collateral blood flow improving but this patient died in 3 week after operation because of pulmonary artery thromboembolia. One patient suffered from bypass thrombosis on next day after operation with following massive ischemia stroke causing death. Two patients were discharged in satisfactory condition with patent bypasses. Conclusion: The performance of high-flow EC-IC bypass is one of the current treatment options for patients with GA of ICA. It is necessary to perform the routine surgery under the conditions of specially equipped operative theatre with the usage of EEG-monitoring, barbiturates and moderate hypothermia. It is possible to perform the urgent high-flow EC-IC bypass in case of intraoperative ICA thrombosis

гигантская интракраниальная аневризмаширокопросветный экстра-интракраниальный анастомозgiant intracranial aneurysmhigh-flow extra-intracranial bypassesReferencesКрылов В.В., Климов А.Б., Полунина Н.А. Диагностика и лечение больных с гигантскими аневризмами сосудов головного мозга. Нейрохирургия, 2010. № 3. - с. 14-24.Крылов В.В., Климов А.Б., Полунина Н.А. Диагностика и лечение больных с гигантскими аневризмами сосудов головного мозга. Нейрохирургия, 2010. № 3. - с. 14-24.Крылов В.В., Климов А.Б., Полунина Н.А. Хирургия гигантских аневризм головного мозга. // Микрохирургия аневризм головного мозга. - М., 2011. Под редакцией В.В. Крылова. Изд-во ИП «Т.А. Алексеева». С. 314-363.Крылов В.В., Климов А.Б., Полунина Н.А. Хирургия гигантских аневризм головного мозга. // Микрохирургия аневризм головного мозга. - М., 2011. Под редакцией В.В. Крылова. Изд-во ИП «Т.А. Алексеева». С. 314-363.Крылов В.В., Нахабин О.Ю., Лукьянчиков В.А. и др. Успешное наложение экстренного широкопросветного экстра-интракраниального анастомоза у больной с гигантской аневризмой офтальмического сегмента левой внутренней сонной артерии // Российский нейрохирургический журнал им. проф. А.Л. Поленова, 2011. Том III, № 4 - с. 44-51.Крылов В.В., Нахабин О.Ю., Лукьянчиков В.А. и др. Успешное наложение экстренного широкопросветного экстра-интракраниального анастомоза у больной с гигантской аневризмой офтальмического сегмента левой внутренней сонной артерии // Российский нейрохирургический журнал им. проф. А.Л. Поленова, 2011. Том III, № 4 - с. 44-51.Лазарев В.А. Клиника, диагностика, хирургическое лечение крупных и гигантских мешотчатых аневризм головного мозга: Автореф.. дис. д-ра мед. наук. - М., 1995.Лазарев В.А. Клиника, диагностика, хирургическое лечение крупных и гигантских мешотчатых аневризм головного мозга: Автореф.. дис. д-ра мед. наук. - М., 1995.Матвеев В.И., Глущенко А.В., Ланецкая В.М. и др. Успешное хирургическое лечение гигантской интракавернозной артериальной аневризмы с применением широкопросветного экстра-интракраниального аутовенозного шунта в условиях системной гипотермии. Нейрохирургия, 2009. № 3. с. 57-61.Матвеев В.И., Глущенко А.В., Ланецкая В.М. и др. Успешное хирургическое лечение гигантской интракавернозной артериальной аневризмы с применением широкопросветного экстра-интракраниального аутовенозного шунта в условиях системной гипотермии. Нейрохирургия, 2009. № 3. с. 57-61.Элиава Ш.Ш., Филатов Ю.М., Сазонова О.Б. и др. Микрохирургическое лечение больших и гигантских аневризм внутренней сонной артерии параклиноидной локализации. Вопросы нейрохирургии. - 1996. - № 4. - с. 3-6.Элиава Ш.Ш., Филатов Ю.М., Сазонова О.Б. и др. Микрохирургическое лечение больших и гигантских аневризм внутренней сонной артерии параклиноидной локализации. Вопросы нейрохирургии. - 1996. - № 4. - с. 3-6.Abdulrauf S.I., Cantando J.D., Mohan Y.S. et al. EC-IC bypass for giant ICA aneurysms. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 231-245.Abdulrauf S.I., Cantando J.D., Mohan Y.S. et al. EC-IC bypass for giant ICA aneurysms. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 231-245.Amin-Hanjani S. Cerebral revascularization: extracranial-intracranial bypass. Neurosurg Sci. 2011 Jun; 55(2): 107-16.Amin-Hanjani S. Cerebral revascularization: extracranial-intracranial bypass. Neurosurg Sci. 2011 Jun; 55(2): 107-16.Atkinson J.L.D., Piepgras D.G. Giant aneurysms: supratentorial. In Neurovascular surgery. Editors Carter L.P., Spetzler R.E. McGraw-Hill Inc. 1995, pp. 815-850.Atkinson J.L.D., Piepgras D.G. Giant aneurysms: supratentorial. In Neurovascular surgery. Editors Carter L.P., Spetzler R.E. McGraw-Hill Inc. 1995, pp. 815-850.Ausman J.I., Diaz F.G., Sadasivan B., Gonzeles-Portillo M. Jr. et al. Giant intracranial aneurysm surgery: the role of microvascular reconstruction. Surg Neurol. 1990 Jul; 34(1): 8-15.Ausman J.I., Diaz F.G., Sadasivan B., Gonzeles-Portillo M. Jr. et al. Giant intracranial aneurysm surgery: the role of microvascular reconstruction. Surg Neurol. 1990 Jul; 34(1): 8-15.Barrow D.L., Alleyne C. Natural history of Gian Intracranial Aneurysms and Indications for Intervention. Clin Neurosurg, 42: 214-244, 1995.Barrow D.L., Alleyne C. Natural history of Gian Intracranial Aneurysms and Indications for Intervention. Clin Neurosurg, 42: 214-244, 1995.Brambilla G., Paoletti P., Rodriguez y Baena R. Extracranialintracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. Report of a case. Acta Neurochir (Wien) 1982; 60(1-2): 63-9.Brambilla G., Paoletti P., Rodriguez y Baena R. Extracranialintracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. Report of a case. Acta Neurochir (Wien) 1982; 60(1-2): 63-9.Brihaye J. Intracavernous carotid artery aneurysms. In: Pia H.W., Langmaid C., Zierski J., eds. Cerebral Aneurysms: Advances in Diagnosis and Therapy. New York, NY: Springer-Verlag: 1979: 67-78.Brihaye J. Intracavernous carotid artery aneurysms. In: Pia H.W., Langmaid C., Zierski J., eds. Cerebral Aneurysms: Advances in Diagnosis and Therapy. New York, NY: Springer-Verlag: 1979: 67-78.de Vasconcellos L.P., Flores J.A.C., Veiga J.C.E. et al. Presentation and treatment of carotid cavernous aneurysms. Arq Neuropsiquiatr 2008; 66(2-A): 189-193.de Vasconcellos L.P., Flores J.A.C., Veiga J.C.E. et al. Presentation and treatment of carotid cavernous aneurysms. Arq Neuropsiquiatr 2008; 66(2-A): 189-193.Eddleman C.S., Getch C.C., Bendok B.R., Batjer H.H. Saphenous vein grafts for high-flow cerebral revascularization. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 125 - 128.Eddleman C.S., Getch C.C., Bendok B.R., Batjer H.H. Saphenous vein grafts for high-flow cerebral revascularization. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 125 - 128.Eddleman C.S., Hurley M.C., Bendok B.R., Batjer H.H. Cavernous carotid aneurysms: to treat or not to treat? Neurosurg Focus 26(5): E4, 2009, 1-10.Eddleman C.S., Hurley M.C., Bendok B.R., Batjer H.H. Cavernous carotid aneurysms: to treat or not to treat? Neurosurg Focus 26(5): E4, 2009, 1-10.Evans J.J., Sekhar L.N., Rak R., Stimac D. Bypass grafting and revascularization in the management of posterior circulation aneurysms. Neurosurgery 55: 1036-1049, 2004.Evans J.J., Sekhar L.N., Rak R., Stimac D. Bypass grafting and revascularization in the management of posterior circulation aneurysms. Neurosurgery 55: 1036-1049, 2004.Hacein-Bey L., Connolly E.S. Jr., Duong H. et al. Treatment of inoperable carotid aneurysms with endovascular carotid occlusion after extracranial-intracranial bypass surgery. Neurosurgery. 1997 Dec; 41(6): 1225-31; discussion 1231-4.Hacein-Bey L., Connolly E.S. Jr., Duong H. et al. Treatment of inoperable carotid aneurysms with endovascular carotid occlusion after extracranial-intracranial bypass surgery. Neurosurgery. 1997 Dec; 41(6): 1225-31; discussion 1231-4.Iwai Y., Sekhar L.N., Goel A. et al. Vein graft replacement of the distal vertebral artery. Acta Neurochir 120 (1-2): 81-87, 1993.Iwai Y., Sekhar L.N., Goel A. et al. Vein graft replacement of the distal vertebral artery. Acta Neurochir 120 (1-2): 81-87, 1993.Kato Y., Sano H., Imizu S., Yoneda M. et al. Surgical strategies for treatment of giant or large intracranial aneurysms: our experience with 139 cases. Minim Invasive Neurosurg. 2003 Dec; 46(6): 339-43.Kato Y., Sano H., Imizu S., Yoneda M. et al. Surgical strategies for treatment of giant or large intracranial aneurysms: our experience with 139 cases. Minim Invasive Neurosurg. 2003 Dec; 46(6): 339-43.Kocaeli H., Andaluz N., Choutka O. et al. Use of radial artery grafts in extracranial-intracranial revascularization procedures. Neurosurg Focus 24: E5, 2008.Kocaeli H., Andaluz N., Choutka O. et al. Use of radial artery grafts in extracranial-intracranial revascularization procedures. Neurosurg Focus 24: E5, 2008.Langer D.J., Vajkoczy P. ELANA: Excimer laser assisted nonocclusive anasthomosis for extracranial-to-intracranial bypass: a rewiev, Skull Base 15: 191-204, 2005.Langer D.J., Vajkoczy P. ELANA: Excimer laser assisted nonocclusive anasthomosis for extracranial-to-intracranial bypass: a rewiev, Skull Base 15: 191-204, 2005.Lawton M.T., Sanai N. IC-IC bypasses for complex brain aneurysms. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 129-144.Lawton M.T., Sanai N. IC-IC bypasses for complex brain aneurysms. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 129-144.Lawton M.T., Spetzler R.F. Surgical strategies for giant intracranial aneurysms. Acta Neurochir (suppl) 1999; 72: 141-156.Lawton M.T., Spetzler R.F. Surgical strategies for giant intracranial aneurysms. Acta Neurochir (suppl) 1999; 72: 141-156.Linskey M.E., Sekhar L.N., Hirsch W. Jr. et al. Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features and pathogenesis. Neurosurgery. 1990; 26: 71-79.Linskey M.E., Sekhar L.N., Hirsch W. Jr. et al. Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features and pathogenesis. Neurosurgery. 1990; 26: 71-79.Martin N.A. The use of extracranial-intracranial bypass for the treatment of giant and fusiform aneurysms. J Stroke Cerebrovasc Dis. 1997 Apr-May; 6(4): 242-5.Martin N.A. The use of extracranial-intracranial bypass for the treatment of giant and fusiform aneurysms. J Stroke Cerebrovasc Dis. 1997 Apr-May; 6(4): 242-5.Michael W.F. Posterior fossa aneurysms simulating tumors. J Neurol Neurosurg Psychiatry. 1974; 37: 218-223.Michael W.F. Posterior fossa aneurysms simulating tumors. J Neurol Neurosurg Psychiatry. 1974; 37: 218-223.Peerlees S.J., Wallace M.C., Drake C.G. Giant intracranial aneurysms. In: Youmans JR, ed. Neurological Surgery. 3rd ed. Philadelphia, Pa: WB Saunders; 1990; 3: 1742-1763.Peerlees S.J., Wallace M.C., Drake C.G. Giant intracranial aneurysms. In: Youmans JR, ed. Neurological Surgery. 3rd ed. Philadelphia, Pa: WB Saunders; 1990; 3: 1742-1763.Regli L., Piepgras D.G., Hansen K.K. Late patency of long saphenous vein bypass grafts to the anterior and posterior circulation. J Neurosurg 83: 806-811, 1995.Regli L., Piepgras D.G., Hansen K.K. Late patency of long saphenous vein bypass grafts to the anterior and posterior circulation. J Neurosurg 83: 806-811, 1995.Sekhar L.N., Natarajan S.K., Ellenbogen R.G., Ghodke B. Cerebral revascularization for ischemia, aneurysms and cranial base tumors. Neurosurgery. June 2008 Suppl.; 62: 1373-1410.Sekhar L.N., Natarajan S.K., Ellenbogen R.G., Ghodke B. Cerebral revascularization for ischemia, aneurysms and cranial base tumors. Neurosurgery. June 2008 Suppl.; 62: 1373-1410.Sekhar L.N., Kalavakonda C. Saphenous vein and radial artery grafts in management of scull base tumors and aneurysms. Operative techniques in neurosurgery 1999; 2: 129-141.Sekhar L.N., Kalavakonda C. Saphenous vein and radial artery grafts in management of scull base tumors and aneurysms. Operative techniques in neurosurgery 1999; 2: 129-141.Sekhar L.N., Bucur S.D., Bank W.O., Wright D.C. Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: Evolution of surgical treatment and improved graft results. Neurosurgery 44: 1207-1224, 1999.Sekhar L.N., Bucur S.D., Bank W.O., Wright D.C. Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: Evolution of surgical treatment and improved graft results. Neurosurgery 44: 1207-1224, 1999.Sekhar L.N., Duff J.M., Kalavakonda C., Olding M. Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: Techniques and outcomes for 17 patients. Neurosurgery 49: 646-659, 2001.Sekhar L.N., Duff J.M., Kalavakonda C., Olding M. Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: Techniques and outcomes for 17 patients. Neurosurgery 49: 646-659, 2001.Sekhar L.N., Kalavakonda C., Elahi F. Cerebral revascularization. In: Atlas of neurosurgical techniques. Brain. Editors: Sekhar L.N., Fessler F.G. Thieme, 2006, pp: : 339-369.Sekhar L.N., Kalavakonda C., Elahi F. Cerebral revascularization. In: Atlas of neurosurgical techniques. Brain. Editors: Sekhar L.N., Fessler F.G. Thieme, 2006, pp: : 339-369.Sekhar L.N., Sen C.N., Jho H.D. Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72: 35-41, 1990.Sekhar L.N., Sen C.N., Jho H.D. Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72: 35-41, 1990.Sekhar L.N., Stimac D., Bakir A. et al. Reconstructions options for complex middle cerebral aneurysms. Neurosurgery 2005; 56(Suppl 1): 66-74Sekhar L.N., Stimac D., Bakir A. et al. Reconstructions options for complex middle cerebral aneurysms. Neurosurgery 2005; 56(Suppl 1): 66-74Spetzler R.F., Riina H.A., Lemole G.M. Giant aneurysms. Neurosurgery. 2001; 49: 902-908.Spetzler R.F., Riina H.A., Lemole G.M. Giant aneurysms. Neurosurgery. 2001; 49: 902-908.Spetzler R.F., Roski R.A., Shuster H., Takaoka Y. The role of EC-IC in the treatment of giant intracranial aneurysms. Neurol Res 1980; 2(3-4): 345-59.Spetzler R.F., Roski R.A., Shuster H., Takaoka Y. The role of EC-IC in the treatment of giant intracranial aneurysms. Neurol Res 1980; 2(3-4): 345-59.Stiebel-Kalish H., Kalish Y., Bar-On R.H., Setton A., Niimi Y., Berenstein A., Kupersmith M.J. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery. 2005 Nov; 57(5): 850-857.Stiebel-Kalish H., Kalish Y., Bar-On R.H., Setton A., Niimi Y., Berenstein A., Kupersmith M.J. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery. 2005 Nov; 57(5): 850-857.Streefkerk H.J., Bremmer J.P., Tulleken C.A. The ELANA technique: High flow revascularization of the brain. Acta Neurochir Suppl 94: 143-148, 2005.Streefkerk H.J., Bremmer J.P., Tulleken C.A. The ELANA technique: High flow revascularization of the brain. Acta Neurochir Suppl 94: 143-148, 2005.Streefkerk H.J., Bremmer J.P., van Weelden M., van Dijk R.R., de Winter E., Beck R.J., Tulleken C.A. The excimer laser-assisted nonocclusive anastomosis practice model: Development and application of a tool for practicing microvascular anastomosis techniques. Neurosurgery 58 [Suppl]: ONS148-ONS156, 2006.Streefkerk H.J., Bremmer J.P., van Weelden M., van Dijk R.R., de Winter E., Beck R.J., Tulleken C.A. The excimer laser-assisted nonocclusive anastomosis practice model: Development and application of a tool for practicing microvascular anastomosis techniques. Neurosurgery 58 [Suppl]: ONS148-ONS156, 2006.Streefkerk H.J., Wolfs J.F., Sorteberg W., Sorteberg A.G., Tulleken C.A. The ELANA technique: Constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm. Acta Neurochir (Wien) 146: 1009-1019, 2004.Streefkerk H.J., Wolfs J.F., Sorteberg W., Sorteberg A.G., Tulleken C.A. The ELANA technique: Constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm. Acta Neurochir (Wien) 146: 1009-1019, 2004.Sundt T.M. Jr, Piepgras D.G. Surgical approach to giant intracranial aneurysms. Operative experience with 80 casees. J Neurosurg Dec; 51(6): 731-42, 1979.Sundt T.M. Jr, Piepgras D.G. Surgical approach to giant intracranial aneurysms. Operative experience with 80 casees. J Neurosurg Dec; 51(6): 731-42, 1979.Sweeney J.M., Sasaki-Adams D.M., Abdulrauf S.I. Radial artery harvest for cerebral revascularization: technical pearls. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 119-124.Sweeney J.M., Sasaki-Adams D.M., Abdulrauf S.I. Radial artery harvest for cerebral revascularization: technical pearls. In: Cerebral revascularization. Techniques in extracranial-to-intracranial bypass surgery. Editor: Saleem I. Abdulrauf. Elsevier Saunders, 2011, pp: 119-124.van der Zwan A., Tulleken C.A., Hillen B. Flow quantitification of the nonocclusive excimer laser-assisted EC-IC bypass. Acta Neurochir 143 (7): 647-654, 2001.van der Zwan A., Tulleken C.A., Hillen B. Flow quantitification of the nonocclusive excimer laser-assisted EC-IC bypass. Acta Neurochir 143 (7): 647-654, 2001.van Doormaal T.P., van der Zwan A., Verweij B.H., Regli L., Tulleken C.A. Giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis bypass. Neurosurgery. 2010 Mar; 66(3): 439-47; discussion 447.van Doormaal T.P., van der Zwan A., Verweij B.H., Regli L., Tulleken C.A. Giant aneurysm clipping under protection of an excimer laser-assisted non-occlusive anastomosis bypass. Neurosurgery. 2010 Mar; 66(3): 439-47; discussion 447.van Doormaal T.P., van der Zwan A., Aboud E., Berkelbach van der Sprenkel J.W., Tulleken C.A., Krisht A.T., Regli L. The sutureless excimer laser assisted non-occlusive anastomosis (SELANA); a feasibility study in a pressurized cadaver model. Acta Neurochir (Wien). 2010 Sep; 152(9): 1603-8; discussion 1608-9. Epub 2010 Jun 30.van Doormaal T.P., van der Zwan A., Aboud E., Berkelbach van der Sprenkel J.W., Tulleken C.A., Krisht A.T., Regli L. The sutureless excimer laser assisted non-occlusive anastomosis (SELANA); a feasibility study in a pressurized cadaver model. Acta Neurochir (Wien). 2010 Sep; 152(9): 1603-8; discussion 1608-9. Epub 2010 Jun 30.van Rooij W.J., Sluzewski M., Beure G.N. Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome. Am J Neuroradiol Jan 2006, 27: 185-189.van Rooij W.J., Sluzewski M., Beure G.N. Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome. Am J Neuroradiol Jan 2006, 27: 185-189.Wei Q.I., Shuo W., Yuan-li Z. et al. Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms Chin Med J 2008; 121(12): 1085-1088.Wei Q.I., Shuo W., Yuan-li Z. et al. Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms Chin Med J 2008; 121(12): 1085-1088.Whittle I.R., Dorsch N.W., Besser M. Giant intracranial aneurysms: diagnosis, management and outcome. Surg Neurol. 1984; 21: 218-230.Whittle I.R., Dorsch N.W., Besser M. Giant intracranial aneurysms: diagnosis, management and outcome. Surg Neurol. 1984; 21: 218-230.Wiebers D.O., Whisnant J.P., Huston J. III et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362: 103110, 2003.Wiebers D.O., Whisnant J.P., Huston J. III et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362: 103110, 2003.Zhu W., Tian Y.L., Zhou L.F. et al. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass. World Neurosurg. 2011 Mar-Apr; 75(3-4): 476-84.Zhu W., Tian Y.L., Zhou L.F. et al. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass. World Neurosurg. 2011 Mar-Apr; 75(3-4): 476-84.

The authors declare that there are no conflicts of interest present.