Differences in Complications and Patency Rates in Young and Elderly Patients Undergoing Extra-Intracranial Bypass Surgery

Introduction: Extra-Intracranial (EC-IC) bypass surgery is commonly used in skull base procedures, such as complex aneurysm surgery and complex tumor resections. With increasing life expectancy, the incidence of patients with complex skull base tumor, hemodynamic insufficiency and complex aneurysm necessitating EC-IC bypass is expected to rise further. It is therefore important to understand the complications and patency rate of elderly patients undergoing EC-IC bypass. We aimed to analyze the complications and patency rate of elderly patients who underwent EC-IC bypass and compare it to a younger cohort.

Methods: This retrospective study included 175 consecutive patients operated with EC-IC bypass from 2003 to 2020. Patients were categorized into binary groups using an age cutoff of 70 years old. Patient charts were retrospectively reviewed for diagnosis, patient presentation, type of bypass, postoperative course, and follow-up. Review of the postoperative course included examination of the postoperative medical and surgical complications. Bypass patency was evaluated with computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA).

Results: A total of 175 patients (74 males, 101 females) underwent arterial bypass during the study period. 158 patients were less than 70 years old compared with 17 patients at least 70 years old. Extracranial to intracranial bypass was performed with a scalp artery in 88.2% cases in the older group and 88.0% cases in the younger group. The younger group was more likely to undergo bilateral bypass (28.1%) than the older group (0%; p = 0.01). There were no significant differences in overall medical and surgical complication rates between older and younger patients undergoing arterial bypass (p = 0.61). Direct postoperative graft patency was similar between groups. Patent bypasses were observed in 91.5% of cases, including 93.8% of elderly patients and 91.3% of younger patients. Patients in the younger age group were more likely to follow-up compared with patients in the older age group, with an average length of follow up of 22.6 months and 8.4 months, respectively (p = 0.02). Follow-up patency data was available in 97.7% of patients (average: 18.0 ± 25.1 months). Graft patency rate on the most recent imaging was 88.3%, with rates 88.2% in the older group (n = 15/17, average 3.3 ± 4.9 months) and 88.3% in the younger group (n = 136/154, average 19.3 ± 25.8 months).

Conclusion: Our data confirm previous data in the literature on the safety and efficacy of EC-IC Bypass in the elderly population. These results suggest that variables other than age may be more important in determining potential benefit from EC-IC bypass treatment.

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Artikel online veröffentlicht:
01. Februar 2023