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. 2021 Feb;35(1):43-50.
doi: 10.1007/s00540-020-02857-w. Epub 2020 Sep 26.

Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

Kenji Yoshitani  1 , Masahiko Kawaguchi  2 , Mikito Kawamata  3 , Manabu Kakinohana  4 , Shinya Kato  5 , Kyoko Hasuwa  5 , Michiaki Yamakage  6 , Yusuke Yoshikawa  6 , Kimitoshi Nishiwaki  7 , Kazuko Hasegawa  7 , Yoshimi Inagaki  8 , Kazumi Funaki  8 , Mishiya Matsumoto  9 , Kazuyoshi Ishida  9 , Atsuo Yamashita  9 , Katsuhiro Seo  10 , Shinichi Kakumoto  10 , Kosuke Tsubaki  2 , Satoshi Tanaka  3 , Takashi Ishida  3 , Hiroyuki Uchino  11 , Takayasu Kakinuma  11 , Yoshitsugu Yamada  12 , Yoshiteru Mori  12 , Shunsuke Izumi  4 , Jun Shimizu  13 , Yuko Furuichi  13 , Nobuhide Kin  14 , Shoichi Uezono  15 , Kotaro Kida  15 , Kunihiko Nishimura  16 , Michikazu Nakai  16 , Yoshihiko Ohnishi  5
Affiliations

Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

Kenji Yoshitani et al. J Anesth. 2021 Feb.

Abstract

Background: Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits.

Methods: Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching.

Results: We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (n = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30-6.51].

Conclusion: CSFD may not be effective for postoperative motor deficits at discharge.

Keywords: Cerebrospinal fluid drainage; Motor deficits; Thoracic aortic surgery.

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