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Anesth Analg 2006;102:1292
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000199213.05558.9C

LETTER TO THE EDITOR

Brown-Séquard Syndrome Following Removal of a Cerebrospinal Fluid Drainage Catheter After Thoracic Aortic Surgery

Madhusudan Rao Puchakayala, MD, and Kevin K. Tremper, MD

Department of Anaesthesia, Wythenshawe Hospital, Manchester, United Kingdom, hvlachtsis{at}hotmail.com (Puchakayala) University of Michigan, Ann Arbor, MI (Tremper)

In Response:

We appreciate Dr. Vlachtsis's comments on our case report (1), and agree with her concern regarding the length of cerebrospinal fluid (CSF) catheter insertion (up to 17 cm). However, there are no specific guidelines (even in neurosurgical literature) regarding the depth of catheter insertion. Neurosurgeons commonly use lumbar CSF catheters of similar lengths and there have been no reported complications. In the study by Cheung et al. (2), lumbar drains used in 432 patients were advanced 7 to 15 cm in the subarachnoid space with no complications relating to spinal cord injury.

CSF drainage and distal aortic perfusion using extracorporeal circulation are the most important techniques in reducing the risk of neurologic deficits after thoracic aortic surgery. Using only 5 cm of catheter in the subarachnoid space can achieve adequate CSF drainage but at a higher risk of being dislodged. We now secure CSF catheters to the skin using a suture in addition to adhesive dressings to prevent displacement.

References

  1. Puchakayala MR, Tremper KK. Brown-Séquard syndrome following removal of a cerebrospinal fluid drainage catheter after thoracic aortic surgery. Anesth Analg 2005;101:322–4.[Abstract/Free Full Text]
  2. Cheung AT, Pochettino A, Guvakov DV, et al. Safety of lumbar drains in thoracic aortic operations performed with extracorporeal circulation. Ann Thorac Surg 2003;76:1190–6.[Abstract/Free Full Text]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press