{"id":"5b1449e8-418c-41b6-9789-2e496a43b0f6","slug":"cerebrospinal-fluid-drains-reduce-risk-of-spinal-cord-injury-for-thoracic-thoracoabdominal-aneurysm-surgery-a-review","title":"Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: A review","authors":["Nancy E. Epstein"],"abstract":"Background: The risk of spinal cord injury (SCI) due to decreased cord perfusion following thoracic/thoracoabdominal aneurysm surgery (T/TL-AAA) and thoracic endovascular aneurysm repair (TEVAR) ranges up to 20%. For decades, therefore, many vascular surgeons have utilized cerebrospinal fluid drainage (CSFD) to decrease intraspinal pressure and increase blood flow to the spinal cord, thus reducing the risk of SCI/ischemia. Methods: Multiple studies previously recommend utilizing CSFD following T/TL-AAA/TEVAR surgery to treat SCI by increasing spinal cord blood flow. Now, however, CSFD (keeping lumbar pressures at 5–12 mmHg) is largely utilized prophylactically/preoperatively to avert SCI along with other modalities; avoiding hypotension (mean arterial pressures >80–90 mmHG), inducing hypothermia, utilizing left heart bypass, and employing intraoperative neural monitoring [somatosensory (SEP) or motor evoked (MEP) potentials]. In addition, preoperative magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) scans identify the artery of Adamkiewicz to determine its location, and when/whether reimplantation/reattachment of this critical artery and or other major segmental/lumbar arterial feeders are warranted. Results: Utilizing CSFD for 15–72 postoperative hours in T/TL-AAA/TEVAR surgery has reduced the risks of SCI from a maximum of 20% to a minimum of 2.3%. The major complications of CSFD include; spinal and cranial epidural/subdural hematomas, VI nerve palsies, retained catheters, meningitis/infection, and spinal headaches. Conclusions: By increasing blood flow to the spinal cord during/after T/TL-AAA/TEVAR surgery, CSFD reduces the incidence of permanent SCI from, up to 10-20% down to down to 2.3-10%. Nevertheless, major complications, including spinal/cranial subdural hematomas, still occur.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/5b1449e8-418c-41b6-9789-2e496a43b0f6/featured/hero-1782420879699.png","publishDate":"2018-02-23T00:00:00.000Z","doi":"10.4103/sni.sni_433_17","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/5b1449e8-418c-41b6-9789-2e496a43b0f6/pdf"}