TY - JOUR
T1 - Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease
AU - Fujimura, Miki
AU - Niizuma, Kuniyasu
AU - Inoue, Takashi
AU - Sato, Kenichi
AU - Endo, Hidenori
AU - Shimizu, Hiroaki
AU - Tominaga, Teiji
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014
Y1 - 2014
N2 - Background: Cerebral hyperperfusion (CHP) is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), and optimal postoperative management has not yet been established. Minocycline, a neuroprotective antibiotic agent, plays a role in blocking matrix metalloproteinase 9 (MMP-9), which contributes to edema formation and hemorrhagic conversion after cerebral ischemia-reperfusion. Patients with MMD have been shown to have increased serum MMP-9 levels. Objective: To examine the effect of minocycline on the prevention of postoperative CHP after STA-MCA anastomosis for MMD. Methods: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 109 hemispheres in 86 consecutive patients with MMD (ages, 9-69 years; mean, 37.2 years). Postoperative systolic blood pressure was strictly maintained at lower than 130 mm Hg in all 109 surgeries. The most 60 recent hemispheres were managed by the intraoperative and postoperative intravenous administration of minocycline hydrochloride (200 mg/d). The incidence of focal neurological deterioration (FND) due to CHP was then compared with that in 36 patients undergoing 49 surgeries managed without minocycline. Results: FND due to CHP was observed in 4 operated hemispheres in patients treated without minocycline (4/49, 8.16%), and in none in the minocycline-treated group (0/60) (P =.0241). Multivariate analysis revealed that minocycline administration (P <.001), surgery on the left hemisphere (P =.031), and a smaller recipient artery diameter (P <.001) significantly correlated with FND due to CHP. Conclusion: The administration of minocycline with strict blood pressure control may represent secure and effective postoperative management to prevent symptomatic CHP after STA-MCA anastomosis for MMD.
AB - Background: Cerebral hyperperfusion (CHP) is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), and optimal postoperative management has not yet been established. Minocycline, a neuroprotective antibiotic agent, plays a role in blocking matrix metalloproteinase 9 (MMP-9), which contributes to edema formation and hemorrhagic conversion after cerebral ischemia-reperfusion. Patients with MMD have been shown to have increased serum MMP-9 levels. Objective: To examine the effect of minocycline on the prevention of postoperative CHP after STA-MCA anastomosis for MMD. Methods: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 109 hemispheres in 86 consecutive patients with MMD (ages, 9-69 years; mean, 37.2 years). Postoperative systolic blood pressure was strictly maintained at lower than 130 mm Hg in all 109 surgeries. The most 60 recent hemispheres were managed by the intraoperative and postoperative intravenous administration of minocycline hydrochloride (200 mg/d). The incidence of focal neurological deterioration (FND) due to CHP was then compared with that in 36 patients undergoing 49 surgeries managed without minocycline. Results: FND due to CHP was observed in 4 operated hemispheres in patients treated without minocycline (4/49, 8.16%), and in none in the minocycline-treated group (0/60) (P =.0241). Multivariate analysis revealed that minocycline administration (P <.001), surgery on the left hemisphere (P =.031), and a smaller recipient artery diameter (P <.001) significantly correlated with FND due to CHP. Conclusion: The administration of minocycline with strict blood pressure control may represent secure and effective postoperative management to prevent symptomatic CHP after STA-MCA anastomosis for MMD.
KW - Cerebral hyperperfusion
KW - Extracranial-intracranial bypass
KW - Minocycline hydrochloride
KW - Moyamoya disease
KW - Surgical complication
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U2 - 10.1227/NEU.0000000000000238
DO - 10.1227/NEU.0000000000000238
M3 - Article
C2 - 24176958
AN - SCOPUS:84893778214
VL - 74
SP - 163
EP - 170
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 2
ER -