Subdural hematoma induced by cerebrospinal fluid drainage: potentially catastrophic complication of spinal cord protection after thoracoabdominal aneurysm repair.
A 50-year-old man underwent replacement of the descending thoracic aorta for a DeBakey type III-b chronic dissecting aortic aneurysm. During the surgery, lumbar cerebrospinal fluid (CSF) drainage with a 10 cm H2O pop-off pressure was used to protect against spinal cord ischemia. During cardiopulmonary bypass, the patient's pupils were isocoric, but anisocoric at end of the operation. As computed tomography of the brain showed right subdural hematoma, neurosurgical drainage was instituted emergently. Although some neurological deficit remained, the patient recovered well and was discharged. This case provides a strong reminder that CSF drainage for spinal cord protection against ischemia might induce subdural hematoma, which can be catastrophic during an operation for thoracoabdominal aortic aneurysm.
Yamauchi
Takashi
T
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Takano
Hiroshi
H
Miyamoto
Yuji
Y
Sawa
Yoshiki
Y
Matsumiya
Goro
G
Matsuda
Hikaru
H
D000784:Aortic Dissection / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004322:Drainage / Q000009:adverse effects*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography