Efficacy of Emergent Cerebrospinal Fluid Drainage on Spinal Cord Injury after Aortic Aneurysm Repair

Junji Nakazawa, Toshiro Ito, Yosuke Kuroda, Toshitaka Watanabe, Ryo Harada, Nobuyoshi Kawaharada

Sapporo Medical University, Sapporo, Japan

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–B

Abstract

Purpose

We assess of the potential efficacy of emergent cerebrospinal fluid drainage (eCSFD) as a treatment for unpredicted neurological deficits caused by spinal cord ischemia after aortic aneurysm repair.

Methods

From January 2007 to November 2017, 1610 patients underwent thoracic or abdominal aortic aneurysm repair. Forty patients developed neurological deficits after the aortic aneurysm repair; among them, 12 patients who had undergone CSFD before the repair or had paraparesis were excluded from the study. In this study, we assessed 28 patients categorized with severe paraplegia, represented as grade 0 or 1 on the modified Tarlov scale (MTS; 0-5 grades). The primary outcome is the improvement on the paraplegia scale to grade 4 or higher by the time of discharge from the hospital.

Result

Aortic aneurysm surgeries included 13 cases of thoracic endovascular repair and 15 cases open repair (9 for thoracic aortic aneurysms, 4 forthoracoabdominal aortic aneurysms, 2 forabdominal aortic aneurysms). Sixteen surgeries were emergency operations. Nineteen patients underwent eCSFD within 8 hours of the onset of paraplegia. There were no significant differences in average age, average MTS grade at the onset of paraplegia, or rate of comorbidities between the eCSFD group and non-eCSFD group. There were significantly more patients (11) with improved paraplegia (MTS grade 4 or higher) in the eCSFD group than in the non-eCSFD group (57.9% vs 0%; p<0.001). After starting eCSFD, 12 of the 19 patients (63.2%) showed improved scale score during eCSFD (48-72 hours). In contrast, no patients in the non-eCSFD group manifested scale improvement 3 days after the onset of paraplegia.

Conclusion

Although there is no standard therapy for unpredicted severe neurological injury after aortic surgeries, eCSFD should be considered a potentially effective treatment.