title: The efficacy and risk of cerebrospinal fluid drainage for thoracoabdominal aortic aneurysm repair: a retrospective observational comparison between drainage and non-drainage.
abstract: We reviewed our experiences with thoracoabdominal aortic aneurysm (TAAA) repair to assess the efficacy of cerebrospinal fluid drainage (CSFD) to prevent the neurological deficits and complications associated with CSFD.
  
  
  
  Between 2002 and 2015, 118 patients underwent TAAA repair. Seventy-eight patients underwent CSFD for 2.7 ± 1.1 days after surgery. CSFD was not performed for the other 40 patients due to an urgent situation, chronic disseminated intravascular coagulation or anatomical difficulties.
  
  
  
  There were 5 in-hospital deaths (4.2%). The neurological complications included paraplegia ( n  = 14, 11.9%), paraparesis ( n  = 3, 2.5%), cerebral infarction ( n  = 11, 9.3%) and intracranial haemorrhage ( n  = 1, 0.85%), none related to CSFD. The complications related to CSFD included headaches ( n  = 13, 11.0%), subdural haematoma (which was treated conservatively) ( n  = 1, 0.85%), a neurological symptom of the bilateral thighs ( n  = 1, 0.85%), pale haemorrhagic discharge ( n  = 2, 1.7%) and a fractured catheter ( n  = 1, 0.85%). Eight patients had paraplegia and 1 patient had paraparesis among the 78 patients who underwent CSFD (9/78, 11.5%); among the 40 patients who did not undergo CSFD, 6 had paraplegia and 2 had paraparesis (8/40, 20.0%). A multivariate analysis demonstrated that CSFD had a significant protective effect for the spinal cord (odds ratio = 0.045, P  = 0.007).
  
  
  
  CSFD effectively prevented spinal cord dysfunction in TAAA repair. However, some serious complications occurred, including subdural haematoma and a fractured catheter. It is therefore important to recognize both the efficacy and the risks of CSFD in TAAA repair.
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Sugiura
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Narita
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshimori
authors.initials: Y
authors.lastname: Araki
authors.affiliation: Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
authors.forename: Kazuro
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Mutsuga
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak / Q000209:etiology*; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010264:Paraplegia / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: Cerebrospinal fluid drainage; Paraplegia; Thoracoabdominal aortic aneurysm