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

DOI：

10.1227/neu.0000000000000238

发表时间：

2014-02-01

期刊：

NEUROSURGERY

影响因子：

4.8

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Fujimura, Miki;Niizuma, Kuniyasu;Tominaga, Teiji

背景：大脑过度灌注(CHP)是颞浅动脉-大脑中动脉(STA-MCA)吻合术治疗烟雾病(MMD)的潜在并发症，目前尚无最佳的术后处理方法。米诺环素是一种神经保护性抗生素，可阻断基质金属蛋白酶9(MMP9)，促进脑缺血再灌流后脑水肿的形成和出血性转化。目的：观察米诺环素对86例患者(年龄9~69岁，平均37.2岁)MMD.METHODS:N-isopropyl-p-[I-123]iodoamphetamine吻合术后1d和7d的单光子发射计算机体层摄影检查，以探讨米诺环素对术后慢性高血压的预防作用。所有109例手术患者术后血压均严格控制在130毫米汞柱以下。60个近侧大脑半球经术中、术后静脉注射盐酸米诺环素(200 mg/d)。结果：在未用米诺环素治疗的患者中，有4个半球发生了CHP所致的局灶性神经功能恶化(FND)(4/49，8.16%)，而米诺环素治疗组(0/60)无一例发生(P=.0241)。多因素分析显示，接受米诺环素治疗(P&lt；.001)、左半球手术(P=.031)和较小的受体动脉直径(P&lt；；结论：严格控制血压的米诺环素可安全有效地预防MMD患者STA-MCA吻合术后症状性CHP的发生。内容涉及：脑血流量、脑血流CHP、脑高灌注EC-IC、颅外-颅内EDMS、脑-十二指肠合成血管病变FND、局灶性神经系统恶化(123)I-IMP-SPECT、N-异丙基-p-[I-123]碘苯丙胺单光子发射计算机断层扫描MCA、大脑中动脉MMD、Moyoya病、基质金属蛋白酶MR9A、磁共振血管成像ECT、单光子发射计算机断层扫描-MCA、颞浅动脉-大脑中动脉

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-123]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.ABBREVIATIONS:CBF, cerebral blood flowCHP, cerebral hyperperfusionEC-IC, extracranial-intracranialEDMS, encephaloduromyosynangiosisFND, focal neurological deterioration(123)I-IMP-SPECT,N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomographyMCA, middle cerebral arteryMMD, moyamoya diseaseMMP-9, matrix metalloproteinase 9MRA, magnetic resonance angiographySPECT, single-photon emission computed tomographySTA-MCA, superficial temporal artery-middle cerebral artery

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

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