The efficacy and risk of cerebrospinal fluid drainage for thoracoabdominal aortic aneurysm repair: a retrospective observational comparison between drainage and non-drainage†

Objectives: We reviewed our experiences with thoracoabdominal aortic aneurysm (TAAA) repair to assess the efficacy of cerebrospinal fluid drainage (CSFD) to prevent the neurological deficits and complications associated with CSFD. Methods: Between 2002 and 2015, 118 patients underwent TAAA repair. Seventy-eight patients underwent CSFD for 2.7 ± 1.1 days after surgery. CSFD was not performed for the other 40 patients due to an urgent situation, chronic disseminated intravascular coagulation or anatomical difficulties. Results: There were 5 in-hospital deaths (4.2%). The neurological complications included paraplegia ( n  = 14, 11.9%), paraparesis ( n  = 3, 2.5%), cerebral infarction ( n  = 11, 9.3%) and intracranial haemorrhage ( n  = 1, 0.85%), none related to CSFD. The complications related to CSFD included headaches ( n  = 13, 11.0%), subdural haematoma (which was treated conservatively) ( n  = 1, 0.85%), a neurological symptom of the bilateral thighs ( n  = 1, 0.85%), pale haemorrhagic discharge ( n  = 2, 1.7%) and a fractured catheter ( n  = 1, 0.85%). Eight patients had paraplegia and 1 patient had paraparesis among the 78 patients who underwent CSFD (9/78, 11.5%); among the 40 patients who did not undergo CSFD, 6 had paraplegia and 2 had paraparesis (8/40, 20.0%). A multivariate analysis demonstrated that CSFD had a significant protective effect for the spinal cord (odds ratio = 0.045, P  = 0.007). Conclusions: CSFD effectively prevented spinal cord dysfunction in TAAA repair. However, some serious complications occurred, including subdural haematoma and a fractured catheter. It is therefore important to recognize both the efficacy and the risks of CSFD in TAAA repair.