[Results of superficial temporal artery-middle cerebral artery anastomosis for elderly and non-elderly patients with cerebral ischemia].
A study was performed to compare the follow-up results of superficial temporal artery-middle cerebral artery anastomosis between a group of nine elderly patients (aged 70 years or over) and another group of 24 non-elderly patients (aged less than 70 years) with cerebral ischemia. The 33 patients, comprising 26 males and seven females, were evaluated pre- and postoperatively by four-vessel angiography, CT scan, MRI and cerebral blood flow (CBF) examination using either xenon inhalation or 123I-IMP SPECT. In some patients, additional evaluations were done. For those with dementia, the minimental scale (MMS), P300 event-related potential, the Hachinski ischemia score, and the vowel word counting test (Kaneko's KANAHIROI) were used, and for the hemiplegic, the Barthel index indicating ability of daily life (ADL) was employed. The results of follow-up for periods ranging from 12 to 55 months were "excellent" (returned to previous job) or "good" (able to perform self-care) in 27 of the 33 patients (81.8%) including six (66.6%) of the elderly group and 21 (87.5%) of the non-elderly group. There was no significant difference between the two groups by statistical evaluation. Among the nine patients with dementia (five under 70, four 70 years of age or over), eight (four under 70, four 70 or over) showed "rapid recovery" with improved postoperative MMS, P300, vowel word counting score and CBF. One patient under 70 (Case 5; a 47-year-old male) with a delayed 2-day recovery from general anesthesia, took as long as 6 months to obtain the self-care ability in daily life. Excluding this patient, all of the remaining eight patients responded quickly to surgery and were able to go home with their families after 2 to 4 weeks, there being no significant difference between the two age groups. In the 14 patients with hemiplegia/paresis (nine under 70, five 70 or over), a definitely better result was obtained for the non-elderly group. Eight of the nine non-elderly patients (89%) showed full ADL (Barthel index 100), whereas only one of three elderly patients (33.3%) showed almost full ADL (Barthel index 97). In five progressive stroke patients, (three under 70, two 70 or over) ultra-early bypass was performed within 8 hours postictus. Definitely better results were obtained in the patients aged less than 70, who showed rapid recovery and were able to return to their previous jobs 1 to 3 months after surgery. In contrast, the two patients aged 70 or over showed no improvement. In this report, we discuss the clinical and physiological variables that may be important for selection of elderly patients for cerebrovascular bypass surgery.
Suzuki
K
K
Department of Neurosurgery, Musashino General Hospital, Kawagoe City, Japan.
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002545:Brain Ischemia / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D002536:Cerebral Arteries / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013699:Temporal Arteries / Q000601:surgery*