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Extracranial-intracranial bypass in the elderly

R Levinthal

    Neurosurgery
    |May 1, 1981
    PubMed
    Summary

    Elderly patients with cerebrovascular insufficiency can safely undergo extracranial-intracranial bypass grafting. This surgical procedure demonstrated minimal complications and mortality in older adults, challenging previous assumptions about their surgical candidacy.

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    Area of Science:

    • Neurosurgery
    • Vascular Surgery
    • Geriatric Medicine

    Background:

    • Cerebrovascular insufficiency symptoms are common in the elderly.
    • Older adults (over 65) are often considered poor surgical candidates, leading to withholding prophylactic procedures.

    Purpose of the Study:

    • To evaluate the safety and efficacy of extracranial-intracranial bypass grafting in elderly patients with cerebrovascular insufficiency.
    • To assess morbidity and mortality rates in this specific patient population.

    Main Methods:

    • Review of a series of 25 elderly patients with cerebrovascular insufficiency.
    • Surgical intervention involved bypass grafting for lesions inaccessible to standard extracranial techniques.
    • Postoperative angiography was performed on patients with temporal-middle cerebral artery anastomoses.

    Main Results:

    • No deaths occurred in the series.
    • Only one neurological complication (hypertensive hematoma) was reported.
    • All bypass grafts in patients with temporal-middle cerebral artery anastomoses were patent post-surgery.
    • The patient with the intracerebral hematoma had the longest postoperative hospitalization (>7 days).

    Conclusions:

    • Extracranial-intracranial bypass grafting is well-tolerated in elderly individuals.
    • The procedure offers minimal morbidity and mortality for this demographic.
    • Surgical intervention should be considered for elderly patients with cerebrovascular insufficiency, challenging prior assumptions.

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