Efficacy and frequency of cerebrospinal fluid drainage in operative management of thoracoabdominal aortic aneurysms

Background: Paraplegia remains the most dreaded complication following thoracoabdominal aortic repair. We investigated the efficacy of cerebrospinal fluid drainage as a spinal cord-protecting modality. We also evaluated the correlation between the frequency of cerebrospinal fluid drainage and the Crawford classification. Methods: Spinal cord function was monitored during 20 open surgical procedures (group I) and 27 stent-graft implantations (group II). Evoked potentials and intracranial pressure were monitored in each operation. If intracranial pressure exceeded 15 mmHg, cerebrospinal fluid was drained. Results: Cerebrospinal fluid drainage was necessary in 75% of patients in group I (Crawford type I: 33%, type II: 40%, type III: 20%, type IV: 7%) and in 22% of patients in group II (Crawford type I: 33%, type If: 66%). Evoked potential alterations correlated with an increase in intracranial pressure. Timely cerebrospinal fluid drainage reversed these changes in 72%. Three patients remained paraplegic. Conclusion: Cerebrospinal fluid drainage is a valuable neuroprotective interventional tool to lower the risk of spinal cord ischemia. The combination of neurophysiological monitoring and cerebrospinal fluid drainage optimizes the prevention of paraplegia during aortic repair.