Minocycline Prevents Focal Neurological Deterioration Due to Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Moyamoya Disease

• Published in: Neurosurgery Vol. 74; no. 2; pp. 163 - 170
• Main Authors: Fujimura, Miki, Niizuma, Kuniyasu, Inoue, Takashi, Sato, Kenichi, Endo, Hidenori, Shimizu, Hiroaki, Tominaga, Teiji
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-02-2014; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adolescent; Adult; Aged; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Antibiotics; Blood pressure; Blood Pressure Determination; Brain - diagnostic imaging; Brain - drug effects; Brain - surgery; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - pathology; Cerebrovascular Disorders - prevention & control; Child; Female; Humans; Male; Middle Aged; Middle Cerebral Artery - drug effects; Middle Cerebral Artery - pathology; Middle Cerebral Artery - surgery; Minocycline - administration & dosage; Minocycline - therapeutic use; Moyamoya Disease - surgery; Neuroprotective Agents - administration & dosage; Neuroprotective Agents - therapeutic use; Neurosurgery; Postoperative Care - methods; Postoperative Complications - prevention & control; Radionuclide Imaging; Reperfusion Injury - etiology; Reperfusion Injury - pathology; Reperfusion Injury - prevention & control; Temporal Arteries - drug effects; Temporal Arteries - pathology; Temporal Arteries - surgery; Veins & arteries; Young Adult; Extracranial-intracranial bypass; Moyamoya disease; Minocycline hydrochloride; Surgical complication; Cerebral hyperperfusion
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000000238

Abstract
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.