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

Neurosurgery ◽  
2013 ◽  
Vol 74 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Miki Fujimura ◽  
Kuniyasu Niizuma ◽  
Takashi Inoue ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Moyamoya Disease ◽  
Single Photon ◽  
Ischemia Reperfusion ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Postoperative Management ◽  
Neurological Deterioration ◽  
Emission Computed Tomography ◽  
Cerebral Hyperperfusion

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.

Focal hyperperfusion after superficial temporal artery—middle cerebral artery anastomosis in a patient with moyamoya disease

2004 ◽  
Vol 100 (1) ◽  
pp. 128-132 ◽  
Author(s):  
Kazuhide Furuya ◽  
Nobutaka Kawahara ◽  
Akio Morita ◽  
Toshimitsu Momose ◽  
Shigeki Aoki ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Single Photon ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Temporal Artery ◽  
Neurological Deterioration ◽  
Perfusion Reserve ◽  
Frontal Operculum

✓ Superficial temporal artery—middle cerebral artery (STA—MCA) anastomosis is a standard surgical therapeutic option in patients with moyamoya disease. Most patients experience improvement in their clinical symptoms immediately after surgery. The authors report on the case of a 39-year-old man with moyamoya disease who suffered from temporary and frequent neurological deterioration after undergoing a left STA—MCA anastomosis. Hemodilution and hypervolemia therapies did not improve his course. Technetium-99m hexamethylpropyleneamine oxime single-photon emission tomography scans demonstrated focal intense accumulation of the tracer in the frontal operculum on the side of the surgery. Although diffusion-weighted magnetic resonance (MR) imaging demonstrated no abnormalities except for the postoperative change, perfusion-weighted MR images and MR digital subtraction angiography revealed focal hyperperfusion in the left frontal operculum where the cerebral perfusion reserve was severely disturbed preoperatively. This evidence strongly supports the notion that focal hyperperfusion observed after STA—MCA anastomosis could occur in the poor perfusion reserve area preoperatively and could cause temporary neurological deterioration.

scholarly journals Cerebral Hyperperfusion Syndrome after Carotid Revascularization: A Brief Review

2019 ◽  
Vol 06 (03) ◽  
pp. 292-298
Author(s):  
Saurabh Anand ◽  
Asish K. Sahoo
Keyword(s):  
Computed Tomography ◽  
Blood Pressure ◽  
Intracranial Hemorrhage ◽  
Cerebral Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Dynamic Imaging ◽  
Neurological Deficits ◽  
Emission Computed Tomography ◽  
Cerebral Hyperperfusion

AbstractCerebral hyperperfusion (CHS) syndrome is a relatively rare but potentially devastating event that can complicate carotid endarterectomy and carotid stenting. It is associated with increased cerebral perfusion usually more than 100% from the baseline along with ipsilateral headache, seizures, focal neurological deficits, encephalopathy, intracranial hemorrhage, or subarachnoid hemorrhage. Various risk factors have been identified but most important risk factor is preprocedure evidence of reduced cerebral vasoreactivity with or without contralateral severe carotid stenosis or occlusion. Although diagnosis is suspected in patients with clinical suspicion, it can be radiologically demonstrated with computed tomography (CT), magnetic resonance imaging (MRI), and by dynamic imaging of cerebral perfusion such as transcranial Doppler (TCD), CT, and MR perfusion, and single-photon emission computed tomography (SPECT). Management is usually centered around prompt recognition and active regulation of blood pressure in perioperative and postoperative periods to limit the rise of cerebral blood flow. Prognosis depends on the early detection and prompt management of CHS. If detected early, coupled with intensive blood pressure management, almost all patients will recover over a period of time. For those patients who are diagnosed late and those progressing to intracranial hemorrhage (ICH), the prognosis is not nearly as good.

Significance of Focal Cerebral Hyperperfusion as a Cause of Transient Neurologic Deterioration After Extracranial-Intracranial Bypass for Moyamoya Disease: Comparative Study With Non-Moyamoya Patients Using N-Isopropyl-p-[123I]Iodoamphetamine Single-Photon Emission Computed Tomography

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 957-965 ◽  
Author(s):  
Miki Fujimura ◽  
Hiroaki Shimizu ◽  
Takashi Inoue ◽  
Shunji Mugikura ◽  
Atsushi Saito ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Potential Complication ◽  
Single Photon Emission ◽  
Neurological Signs ◽  
Cerebral Hyperperfusion ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Abstract BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis prevents cerebral ischemic attack by improving cerebral blood flow in patients with occlusive cerebrovascular disease and hemodynamic compromise. Recent evidence suggests that focal cerebral hyperperfusion is a potential complication of this procedure for moyamoya disease. OBJECTIVE: To clarify the exact differences in the incidence and clinical manifestations of this phenomenon between patients with and without moyamoya disease. METHODS: N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 121 hemispheres from 86 consecutive patients with moyamoya disease (2–67 years of age; mean, 34.3 years) and on 28 hemispheres from 28 non-moyamoya patients (12–67 years of age; mean, 56.5 years). The incidence of symptomatic hyperperfusion, defined as a significant focal increase in cerebral blood flow at the site of the anastomosis that is responsible for the apparent neurological signs, was compared between groups. RESULTS: Symptomatic cerebral hyperperfusion including mild focal neurological signs was seen in 25 patients with moyamoya disease (26 hemispheres, 21.5%) but in none of the patients without moyamoya disease (P = .0069). Multivariate analysis revealed that moyamoya disease was significantly associated with the development of symptomatic cerebral hyperperfusion (P = .0008). All patients with symptomatic hyperperfusion were relieved by intensive blood pressure control, and no patients suffered from permanent neurological deficit caused by hyperperfusion. CONCLUSION: Symptomatic cerebral hyperperfusion is a potential complication of STA-MCA anastomosis, especially in patients with moyamoya disease. Accurate diagnosis and adequate management of hyperperfusion are recommended, especially in patients with moyamoya disease.

Incidence and Pathogenesis of Transient Cheiro-Oral Syndrome After Surgical Revascularization for Moyamoya Disease

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 1054-1060 ◽  
Author(s):  
Toru Sasamori ◽  
Satoshi Kuroda ◽  
Naoki Nakayama ◽  
Yoshinobu Iwasaki
Keyword(s):  
Moyamoya Disease ◽  
Single Photon ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Temporal Artery ◽  
Disease Stage ◽  
Emission Computed Tomography ◽  
Rapid Progression ◽  
Surgical Revascularization ◽  
Progression Of Disease

Abstract BACKGROUND: There are no reports that denote transient cheiro-oral syndrome (COS) after surgical revascularization for moyamoya disease. OBJECTIVE: To clarify the incidence and pathogenesis of transient COS after surgical revascularization for moyamoya disease. METHODS: This study included 21 patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass because of Moyamoya disease. Their medical records were evaluated to identify clinical features of postoperative transient COS. The findings on MRI, magnetic resonance angiography, and single-photon emission computed tomography were also analyzed. RESULTS: Transient COS developed in 8 (22.9%) of 35 operated hemispheres, or in 6 (28.6%) of 21 patients between 3 and 20 days after surgery. Most of the COS were associated with mild weakness of the ipsilateral face and hand. Simultaneous radiological studies detected no findings of cerebral infarct or postoperative hyperperfusion. STA-MCA anastomosis was patent in all patients. However, their disease stage more frequently progressed owing to considerable blood flow via STA-MCA anastomosis, and basal moyamoya vessels disappeared or diminished in patients with transient COS rather than in those without. CONCLUSION: Transient COS after surgical revascularization for moyamoya disease is not rare. Bypass flow through STA-MCA anastomosis may stimulate a rapid progression of disease stage and diminish basal moyamoya vessels, causing transient COS within 3 weeks after surgery.

Is Precise Targeting of the Recipient Artery in a Superficial Temporal Artery–Middle Cerebral Artery Anastomosis Crucial?

2019 ◽  
Vol 80 (06) ◽  
pp. 441-453
Author(s):  
Hiroyuki Katano ◽  
Hiroshi Yamada ◽  
Yusuke Nishikawa ◽  
Kazuo Yamada ◽  
Shigenori Miyachi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Single Photon ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Temporal Artery ◽  
Visual Assessment ◽  
Emission Computed Tomography ◽  
Recipient Artery ◽  
Visual Group

Abstract Objective To investigate the difference in treatment outcomes according to the method used to select the recipient artery in superficial temporal artery–middle cerebral artery (STA-MCA) anastomoses. Methods We retrospectively analyzed the cases of 35 patients who underwent an STA-MCA anastomosis for internal carotid artery/MCA occlusion or stenosis. Patients were divided into two groups based on whether the recipient artery was precisely targeted by single-photon emission computed tomography (SPECT group) or less precisely targeted by visual assessment (Visual group). Then the bypass results in both groups were evaluated postoperatively based on changes in the regional cerebral blood flow (rCBF) and clinical outcomes. Results The delineated recipient artery in magnetic resonance angiography (MRA) matched the intraoperatively selected artery in 87.6% of the SPECT group cases and 83.3% of the Visual group cases. The SPECT group's digital subtraction angiography (DSA) findings coincided with the intraoperative selection in 76.9% of cases, and the MRA findings corresponded with the DSA findings in 92.3%. The postoperative areas with increased rCBF matched the perfused areas of intraoperatively selected arteries in 80.0% of the SPECT group cases and 77.8% of the Visual group cases. Postoperatively increased rCBF areas matching totally or partially with preoperative low-perfusion areas were observed in all cases. Conclusions The present results revealed no significant differences in the change in rCBF in the low-perfusion area between the patients whose recipient arteries were selected by SPECT or visual assessment.

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