title: Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease.
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-[I]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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; ‡Department of Neurosurgery, National Hospital Organization, Sendai Medical Center, Sendai, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Niizuma
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.forename: Hidenori
authors.initials: H
authors.lastname: Endo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001795:Blood Pressure Determination; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D008911:Minocycline / Q000008:administration & dosage / Q000627:therapeutic use*; D009072:Moyamoya Disease / Q000601:surgery*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011877:Radionuclide Imaging; D015427:Reperfusion Injury / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D013699:Temporal Arteries / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D055815:Young Adult
chemical_list: D018696:Neuroprotective Agents; D008911:Minocycline