title: [Acute subdural hematoma secondary to cerebrospinal fluid drainage during thoracic endovascular aortic repair (TEVAR): A case report].
abstract: We report a case of acute subdural hematoma which occurred following cerebrospinal fluid (CSF) drainage during thoracic endovascular aortic repair (TEVAR) surgery. A 63-year-old woman was scheduled to receive TEVAR for thoracic-abdominal aneurysm extending from the descending aorta (T10) to 15 mm above the celiac trunk. Before the TEVAR operation, a lumbar cerebrospinal drain was inserted at L4-5. CSF pressure was maintained at 10cmH2O throughout the operation. The surgical procedure was completed uneventfully. At the end of the surgery, the attending anesthesiologist recognized an inequality in the patient's pupil size. Emergency CT scan reviewed left acute subdural hematoma. The patient underwent emergency external decompression surgery. The benefits of CSF drainage for spinal cord protection is well established, and ischemia of Adamkiewicz artery is prevented by careful control of CSF pressure. However, the use of CSF drainage has been associated with the risk of acute subdural hematoma. Careful observation for amount of CSF drainage is necessary during thoracoabdominal aortic aneurysm repair.
authors.affiliation: Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita 565-0871.
authors.forename: Nao
authors.initials: N
authors.lastname: Hamabe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iritakenishi
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Imada
authors.forename: Takashi
authors.initials: T
authors.lastname: Mashimo
mesh_terms: D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002445:Celiac Artery; D002555:Cerebrospinal Fluid; D019299:Decompression, Surgical; D004322:Drainage / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects