Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Jiّی Fiedler , Vladimیr Pّibلٍ , Ondّej ٹkoda , Ivo Schenk , Vىra Schenkovل , Simona Polلkovل
- چاپ و سال / کشور: 2011
Description
Objective The purpose of this study was to evaluate cognitive functions in patients undergoing extracranialintracranial (EC-IC) bypass surgery for cerebral ischemia. Population and methods From August 2003 to January 2009, 276 patients with occluded internal carotid arteries (ICA) were screened. Forty of these met the criteria for a low-flow EC-IC bypass. These patients were identified based on evidence of exhausted vasomotor reactivity (VMR) using the Doppler CO2 test and CT perfusion. These patients were invited to have a complete battery of neuropsychological tests preoperatively and 12 months after surgery. Complete neurocognitive testing was finished in 20 patients. Results This group of 20 patients showed preoperative cognitive impairment ranging from mild to medium-severe. There were no cases of stroke ipsilateral to the operated side during the follow-up period. VMR improvement was seen in all patients within 6 months of surgery. A comparison using a paired t-test demonstrated significant improvement 12 months after surgery in the following neuropsychological tests: WAIS-R (p=0.01), Number Collection Test (p=0.02), Trail Making Test (p=0.03), and Benton Visual Retention Test (p=0.05). Repeat analysis of variance (ANOVA) suggested the following predictors associated with cognitive improvement:the presence of ophthalmic collateral flow (p=0.04), preoperative amaurosis fugax (p=0.02), and external watershed infarction detected by MRI (p=0.04). Conclusion Patients with occlusion of the ICA and exhausted VMR have cognitive impairment prior to ECIC bypass surgery. Twelve months after surgery, there is significant improvement in various areas of cognition.
Acta Neurochir (2011) 153:1303–1312 DOI 10.1007/s00701-011-0949-x Received: 22 September 2010 / Accepted: 13 January 2011 / Published online: 6 February 2011 # Springer-Verlag 2011
