Complications of cerebrospinal fluid drainage after open descending thoracic and thoracoabdominal aortic aneurysm repair

Abstract

Objective: This study aimed to review a 10-year experience, identify cerebrospinal fluid drainage (CSFD)-related complications, and evaluate its usefulness in spinal cord protection.

Methods: This retrospective study reviewed all open descending thoracic aneurysm and thoracoabdominal aortic aneurysm (DTA/TAAA) repairs performed at our institution between January 2013 and September 2024. The analysis focused on patients who underwent CSFD for preoperative spinal cord protection.

Results: Of the 428 patients who underwent open DTA/TAAA repair, 339 received CSFD and were included in the analysis. DTA was performed in 107 patients (31.7%), and TAAA was performed in 232 (68.4%). Emergency surgeries were required in 40 patients (11.8%). Operative mortality was 5.3% (18 patients). Early spinal cord injury was observed in 10 (2.9%), and delayed spinal cord injury occurred in 36 (10.6%). The mean duration of CSFD drainage was 3.4 ± 1.9 days. CSFD-related complications were observed in 85 patients (25.1%), with major complications, including intracranial hemorrhage in 7 (2.1%), 1 of which required surgical intervention (0.3%). Meningitis was noted in two patients (0.6%). Minor complications included spinal headache in 55 (16.2%) and CSFD leakage in 27 (8.0%). Bloody drainage occurred in 29 (8.6%) and CSFD catheter malfunction in 9 (2.7%), rendering CSFD unusable in 18 patients (5.3%).

Conclusions: Open DTA/TAAA repairs with CSFD showed acceptable outcomes. Although minor complications were relatively frequent, major complications were rare at this experienced center.

Keywords: CSFD; Cerebrospinal fluid drainage; DTA; Open descending thoracic and thoracoabdominal aortic aneurysm; SCI; Spinal cord injury; TAAA.