title: Meningeal haemorrhage secondary to cerebrospinal fluid drainage during thoracic endovascular aortic repair.
abstract: Thoracic endovascular aortic repair (TEVAR) has shown lower mortality compared with open surgical repair (OSR). However, the risk of spinal cord ischaemia (SCI) remains similar than OSR. As a prophylactic measure to reduce the risk of SCI, cerebrospinal fluid (CSF) drainage has been widely used in OSR. In TEVAR, the utility of this adjunct is still controversial. We report a case of a 56-year-old man referred for TEVAR for a descending thoracic aneurysm that previously underwent an abdominal aneurysmectomy with aortobifemoral bypass graft. On the day before, a lumbar cerebrospinal drain was placed prophylactically. Forty-eight hours after the procedure, meningeal symptoms without neurological deficits developed. Clinical investigation revealed meningeal haemorrhage. Therapy with nimodipine was initiated with symptomatic relief. Evidence from randomized controlled trials supporting the role of CSF drainage in TEVAR is still lacking. We discuss the current recommendations, potential benefits and risks and cautions associated with CSF drainage in TEVAR.
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mancio
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pires-Morais
authors.affiliation: Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Research and Developement Unit, Faculty of Medicine , University of Porto , Porto , Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Santos
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Melica
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Braga
authors.affiliation: Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal.
authors.forename: Vasco Gama
authors.initials: VG
authors.lastname: Ribeiro