Minocycline as a Neuroprotective Perioperative Antibiotic in Skull Base Tumors and Prevention of Delayed Facial Palsies (in Acoustic Neuromas), a Before and After Study

Introduction: An explanation for delayed neurological worsening is postoperative edema that occurs in the first few postoperative days. Late (7 to 10 days postoperatively) delayed facial palsy is a complication that is outside the regular time interval for “swelling.” Minocycline is a neuroprotective antibiotic. The use of minocycline as a perioperative antibiotic and the rate of delayed facial palsy in acoustic neuroma patients are reviewed.

Methods: Starting July 2005, all skull base patients operated on by the senior author received minocycline as a perioperative antibiotic. Data were collected prospectively since 2002. Acoustic neuroma patients within this group were reviewed and the incidences of early (postoperative day 1 to 4) and late (postoperative day 7 to 10) delayed palsies (defined as immediate postop House-Brackmann grade 1 or 2, progressing to grade 4 or worse) were reviewed.

Results: There were 122 acoustic neuromas operations (November 2002 to 2006, mean maximum diameter, 2.6 cm, SD1.1 cm). Three with prior radiation were excluded. Ninety-four percent woke up with immediate H-B grade 1 or 2. There were 3 early and 8 late delayed palsies in the 85 patients who did not get minocycline. There was 1 early and 0 late delayed palsy in the 34 minocycline patients (p = 0.04 early + late, p = 0.03 late delayed palsies). All 12 patients recovered to H-B grade 1 or 2.

Conclusion: Minocycline may have neuroprotective effects in preventing delayed facial palsies. Other skull base tumors/structures may benefit as well. This is a preliminary study; more work is required.