gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

The extra-intracranial bypass for treatment of carotid artery occlusion and cerebral hemodynamic insufficiency in the elderly – perioperative risks and outcome

Meeting Abstract

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  • N. Sandow - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • P. Vajkoczy - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 004

DOI: 10.3205/11dgnc225, URN: urn:nbn:de:0183-11dgnc2257

Published: April 28, 2011

© 2011 Sandow et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. The selection of patients is primarily based on angiographic and functional CBF criteria. Traditionally, an age of 70 served as an arbitrary cut-off for patients qualifying for bypass surgery. However, demographic changes increase life expectancy and therefore, an increasing number of elderly patients present with cerebrovascular hemodynamic insufficiency. We therefore designed a retrospective study to address the question whether EC-IC-bypass is a safe and efficient treatment in the patient cohort > 70 years.

Methods: From May 2008 to November 2010, 44 patients (group A: 13 patients >70 years, mean = 73.4 years SE: 1.4; group B: 30 patients < 70 years, mean = 61.3 years SE: 1.1) suffering from symptomatic carotid artery occlusion due to atherosclerotic disease underwent EC-IC-(superficial temporal to middle cerebral / STA-MCA)-bypass-surgery. We analyzed bypass function, short-term outcome and the incidence of perioperative events in both groups retrospectively.

Results: Mortality after STA-MCA-bypass surgery was 0% in both groups. Similarily, permanent neurological deficits did not occur in both groups. Mild complications (wounds infections, CSF leakage) and transient neurological deficits occurred in both groups without significant differences (A: 23.1%, B: 13.3%, p = 0.655). Length of ICU stay in group A was 2.9 days (SE: 0.9) compared to 1.9 days (SE: 0.3) in group B (p = 0.539). Early postoperative bypass patency was 93% and 91% in groups A and B, respectively (p = 0.671). In order to assess short-term surgical and clinical outcome bypass patency as well as occurrence of new ischemic events, the patients were evaluated with a mean follow-up of 5.7 months (SE: 0.8). In both groups there was no secondary bypass occlusion and no new ischemic events occurred.

Conclusions: In patients > 70 years, STA-MCA bypass patency, prevention of ischemic events and morbidity were comparable to patients < 70 years. STA-MCA bypass surgery is a safe and successful therapeutic procedure in elderly patients.