D.V. Vakatov, O.N. Dreval, V.A. Lazarev, A.N. Borzunov, A.V. Gorozhanin
(Botkin Municipal Clinical Hospital, Moscow;
Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow)
There is a tendency to the aging of population, watched all over the world. According to the WHO (2001), more than 1/5 of the Russian population is above 60. The data of the Center of Ecology and Demography show, that a quota of the elderly in Russia can be as high as 45% by 2005. Despite all achievements of modern medicine diagnosis of cerebral neoplasms in elderly and senile people leaves much to be desired, as 50% of all tumors are revealed only during postmortem examination (Tigliev G.S., 2001: Panov E.I., 2003). Persons above 70 account for 67% of such cases. More than a half of the elderly cannot look after themselves in a postoperative period and need constant care.
The research goal was to determine main clinical criteria, whose correction would allow to improve results of surgical treatment of elderly and senile cases with cerebral neoplasms of supratentorial localization.
Materials and Methods. There were 206 cases above 60, who had cerebral tumors of supratentorial localization. The research was carried out in 1998-2002. Age peculiarities of the disease manifestations, dynamics of a clinical state on admission and during a postoperative period were analyzed.
We found out, that a course of an early postoperative period was dependent on accompanying diseases and an initial level of self-service. Main risks of postoperative complications and mortality causes were estimated. Taking into account predominance of postoperative vascular complications in elderly and senile patients, transcranial Doppler examination of a cerebral vascular system was carried out, using hypercapnia and orthostatic tests. Elderly cases were characterized by increased velocity of cerebral blood flow against a background of hyporeactivity and its absence.
The results demonstrated necessity of correction of cerebrovascular reactivity in a preoperative period, as it permitted to improve a level of cerebral blood flow in compliance with metabolic demands. Functional potentialities of a vascular system in the elderly were determined for ensuring adequate vascular-metabolic therapy.