Observations on delayed neurologic deficit after thoracoabdominal aortic aneurysm repair

Purpose: To describe the phenomenon of delayed-onset neurologic deficit after thoracoabdominal aortic aneurysm repair and to discuss management of this type of deficit in a case series. Methods: Since September 1992 we have used cerebrospinal fluid drainage and distal aortic perfusion routinely to reduce the risk of neurologic deficit in thoracoabdominal aortic aneurysm patients. All patent intercostal arteries were reattached when this was technically feasible. Delayed neurologic complications occurred in eight patients who underwent operation for thoracoabdominal aortic aneurysm between September 1992 and March 1997, between 1 and 14 days after awakening from anesthesia. All patients had immediate cerebrospinal fluid drainage on recognition of their symptoms. Results: Patients were evaluated by an independent neurologist and were classified by a modified Tarlov score between 0 and 5. All eight patients improved at least two points by discharge. The mean change in Tarlov score from onset to discharge was 2.4 +/- 1.1 (p = 0.008). Conclusions: Cerebrospinal fluid drainage significantly improved late-onset neurologic deficit that occurred between 1 day and 2 weeks after operation in our series. Immediate drainage should be considered when signs of neurologic deficit first begin to appear.