Introduction: Cerebral hyperperfusion (CHP) is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (Ref. 1), while optimal postoperative management protocol has not been established. Minocycline has a potential role for preventing matrix metalloproteinase (MMP)-9 which contribute to the edema formation and hemorrhagic conversion after cerebral ischemia-reperfusion injury. Furthermore, patients with moyamoya disease are reported to have increased serum MMP-9 level. Thus we examined the effect of minocycline on preventing postoperative CHP after STA-MCA anastomosis for moyamoya disease.
Methods: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 169 hemispheres from 121 consecutive patients with moyamoya disease (2–69, mean 33.5 years). Most recent 19 patients were managed by intra-operative and postoperative intravenous administration of minocycline hydrochloride (200mg/day). Then incidence of symptomatic CHP and ischemic complication was compared with 105 patients undergoing 147 surgeries managed without minocycline.
Results: Symptomatic CHP was seen on 27 operated hemispheres in non-minocycline group (27/147, 18.4%), but only on 1 in minocycline-treated group (1/22, 4.5%). Transient focal neurologic deterioration due to CHP was evident on 24 hemispheres in non-minocycline group (24/147, 16.3%), while on none in minocycline-treated group (0/22, p=0.040). Ischemic complication was seen on 4 operated hemispheres in non-minocycline group (4/147, 2.7%), while on none in mincycline-treated group (0/22). There was no adverse effect of minocycline after 22 surgeries.
Conclusions: Administration of minocycline in combination with strict blood pressure control may contribute to prevent focal neurological deterioration due to CHP after STA-MCA anastomosis for moyamoya disease.
Patient Care: Our reult suugests minocycline administration contributes to safer postoperative management after revascularization surgery for moyamoya disease.
Learning Objectives: Intensive blood pressure control in combination with minocycline administration reduces the risk of postoperative symptomatic CHP after STA-MCA anastomosis for moyamoya disease.
References: 1. Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T. Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after EC-IC bypass for moyamoya disease: Comparative study with non-moyamoya patients using 123I-IMP-SPECT. Neurosurgery 68:957-965, 2011