title: A systematic review of spinal cord injury and cerebrospinal fluid drainage after thoracic aortic endografting.
abstract: BACKGROUND
  The use of thoracic endovascular aneurysm repair (TEVAR) is increasing. Similar to open repair, TEVAR carries a risk of spinal cord ischemia (SCI). We undertook a systematic review to determine whether preoperative cerebrospinal fluid (CSF) drainage reduces SCI.
  
  
  METHODS
  PubMed, the Cochrane Library, and conference abstracts were searched using the keywords thoracic endovascular aortic repair, cerebrospinal fluid, spinal cord ischaemia, TEVAR, and aneurysm. Studies reporting SCI rates and CSF drain rates for TEVAR patients were eligible for inclusion. SCI rates across studies were pooled using random-effects modeling. Study quality was evaluated using the Downs and Black score.
  
  
  RESULTS
  Study quality was generally poor to moderate (median Downs and Black score, 9). The systematic review identified 46 eligible studies comprising 4936 patients; overall, SCI affected 3.89% (95% confidence interval, 2.95.05%-4.95%). Series reporting routine prophylactic drain placement or no prophylactic drain placement reported pooled SCI rates of 3.2% and 3.47%, respectively. The pooled SCI rate from 24 series stating that prophylactic drainage was used selectively was 5.6%.
  
  
  CONCLUSIONS
  Spinal chord injury is uncommon after TEVAR. The role of prophylactic CSF drainage is difficult to establish from the available literature. High-quality studies are required to determine the role of prophylactic CSF drainage in TEVAR.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Chee S
authors.initials: CS
authors.lastname: Wong
authors.forename: Donagh
authors.initials: D
authors.lastname: Healy
authors.forename: Catriona
authors.initials: C
authors.lastname: Canning
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Boyle
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002555:Cerebrospinal Fluid; D004322:Drainage; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000517:prevention & control*