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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 212-216
DOI: 10.4103/ajns.AJNS_485_20
Case Report

Impact of extracranial–Intracranial bypass on cognitive function in a patient with chronic cerebral ischemia

Toshiya Aono
Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka
,
Hideaki Ono
Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka
,
Tomohiro Inoue
1   Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo
,
Takeo Tanishima
Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka
,
Akira Tamura
Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka
,
Isamu Saito
Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka
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Extracranial–intracranial (EC-IC) arterial bypass surgery was developed to prevent subsequent stroke by improving hemodynamics distal to the occluded intracranial artery, but its utilization has been decreasing due to the development in medical treatment. However, EC-IC bypass surgery may be effective for arresting or reversing cognitive decline in patients with cerebral ischemia. A 69-year-old man with the left internal carotid artery occlusion that manifested as scattered cerebral infarction of the left hemisphere presented with dysarthria and transient right hemiparesis. Hemodynamic condition was impaired in the left side, and therefore, EC-IC bypass surgery was performed to prevent recurrence of cerebral infarction. Neuropsychological examination at 6 months after the surgery showed marked improvement as compared to the preoperative examination and there was no recurrence of stroke in the patient. EC-IC bypass may contribute to the improvement of cognitive function as well as the prevention of recurrence of cerebral infarction in patients with hemodynamic insufficiency, but there might be a threshold of hemodynamic impairment with respect to the reversibility of cognitive performance. Investigation of the target and timing can identify cases in which the cognitive function is improved by surgery.

Key-words:

Cerebral ischemia - cognitive function - extracranial–intracranial bypass - intracranial steno-occlusive disease

Financial support and sponsorship

Nil.




Publication History

Received: 29 October 2020

Accepted: 04 January 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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