Neuraxial hematoma following lumbar cerebrospinal fluid drainage in thoracic endovascular aortic repair

Cerebrospinal fluid drainage is recommended for spinal cord protection in open and endovascular thoracoabdominal aortic aneurysm (TAAA) repairs. We report a case of spinal hematoma following lumbar drain removal in a patient who underwent thoracic endovascular aortic repair for DeBakey type III aortic dissection. There is always a debate concerning placement of lumbar drain on the day of the procedure, postponement of the procedure if a traumatic tap is encountered and type of spinal catheter to avoid spinal hematoma in TAAA repairs. The practice of timing of catheter placement and choice of the type of catheter for lumbar varies with institutional practice, and there has been no recommendation regarding the safe practice for avoiding spinal hematoma. Avoiding traumatic tap during lumbar drain placement, team approach of an anesthesiologist, an interventional cardiologist, and a surgeon for decision-making to continue or postpone the procedure and timing of anticoagulation, meticulous neurological monitoring throughout the hospital stay of the patient can avoid spinal hematoma and sequelae.