Efficacy and frequency of cerebrospinal fluid drainage in operative management of thoracoabdominal aortic aneurysms.
BACKGROUND
Paraplegia remains the most dreaded complication following thoracoabdominal aortic repair. We investigated the efficacy of cerebrospinal fluid drainage as a spinal cord-protecting modality. We also evaluated the correlation between the frequency of cerebrospinal fluid drainage and the Crawford classification.


METHODS
Spinal cord function was monitored during 20 open surgical procedures (group I) and 27 stent-graft implantations (group II). Evoked potentials and intracranial pressure were monitored in each operation. If intracranial pressure exceeded 15 mmHg, cerebrospinal fluid was drained.


RESULTS
Cerebrospinal fluid drainage was necessary in 75 % of patients in group I (Crawford type I: 33 %, type II: 40 %, type III: 20 %, type IV: 7 %) and in 22 % of patients in group II (Crawford type I: 33 %, type II: 66 %). Evoked potential alterations correlated with an increase in intracranial pressure. Timely cerebrospinal fluid drainage reversed these changes in 72 %. Three patients remained paraplegic.


CONCLUSIONS
Cerebrospinal fluid drainage is a valuable neuroprotective interventional tool to lower the risk of spinal cord ischemia. The combination of neurophysiological monitoring and cerebrospinal fluid drainage optimizes the prevention of paraplegia during aortic repair.
Weigang
E
E
Department of Cardiovascular Surgery, University Medical Center Freiburg, Freiburg, Germany. ernst.weigang@web.de
Sircar
R
R
von Samson
P
P
Hartert
M
M
Siegenthaler
M P
MP
Luehr
M
M
Richter
H
H
Szabó
G
G
Czerny
M
M
Zentner
J
J
Beyersdorf
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation; D002555:Cerebrospinal Fluid / Q000737:chemistry*; D004322:Drainage; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013116:Spinal Cord / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects