もやもや病に対する血行再建術後 過灌流に対するミノサイクリンを用いた周術期管理の現状と問題点

Abstract

Background: Cerebral hyperperfusion syndrome is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD). Prophylactic blood pressure lowering in combination with the use of minocycline, a neuroprotective antibiotic agent, has been suggested to reduce the risk of cerebral hyperperfusion. We therefore aimed to evaluate the results of this procedure in our larger series.Methods: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 89 hemispheres from 75 consecutive patients with MMD (10-66, mean 38 years old). Postoperative systolic blood pressure was strictly controlled under 130 mmHg with the intra-operative and postoperative intravenous administration of minocycline hydrochloride (200 mg/day). Then we investigated the incidence of perioperative neurological deterioration and radiological adverse events such as delayed intracranial hemorrhage.Results: All patients underwent technically successful revascularization surgeries, and none of them suffered permanent neurological deterioration postoperatively. Three patients suffered transient ischemic attack in the acute stage (3.4%), and one patient suffered delayed intracerebral hemorrhage (ICH), which caused transient aphasia (1.1%). Six patients (mean age of 51.3 years) demonstrated delayed intracranial hemorrhage (subarachnoid hemorrhage in 5, and ICH in one) (6.7%) while five of them remained asymptomatic.Conclusion: The administration of minocycline with strict blood pressure control may represent secure and effective postoperative management after STA-MCA anastomosis for MMD, while delayed intracranial hemorrhage, either symptomatic or asymptomatic, is a potential complication of this procedure.