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LETTERS TO THE EDITOR

Reversal of Delayed Paraplegia with Cerebrospinal Fluid Drainage after Thoracoabdominal Aneurysm Repair

Departments of Cardiovascular Anesthesiology and Surgery, Texas Heart Institute, Saint Luke’s Episcopal Hospital, Houston, TX

To the Editor:

Delayed neurologic deficits are an uncommon, yet devastating complication of thoracoabdominal aortic aneurysm repair occurring in up to 3% of patients (1). Although the mechanisms of delayed spinal cord ischemia remain ill defined, factors known to increase the risk of spinal cord injury include the aortic cross-clamp time, aneurysm extent, aneurysm rupture, and associated acute aortic dissection. Although multiple studies have suggested a role for intraoperative cerebrospinal fluid (CSF) drainage in preventing acute spinal cord injury, comparatively little information exists regarding the usefulness of postoperative CSF drainage for treatment of delayed neurological deficits occurring after thoracoabdominal aneurysm repair (2–4). We report a case of complete reversal of delayed neurologic deficits with postoperative CSF drainage. A 71-yr-old man experienced delayed onset lower extremity paraplegia 48 h after uncomplicated Type I thoracoabdominal aneurysm repair. Insertion of an epidural catheter into the lumbar thecal space revealed increased CSF pressures (>10 mm Hg). Prompt CSF decompression, in association with IV steroid administration, completely reversed the neurologic deficits within 24 h of onset. This case suggests that postoperative CSF drainage may be a useful therapeutic option for the management of delayed onset neurological deficits inpatients with increased CSF pressures after thoracoabdominal aneurysm repair.

References

1. Safi HJ, Hess KR, Randel M, et al. Cerebrospinal fluid drainage and distal aortic perfusion: reducing neurologic complications in repair of thoracoabdominal aortic aneurysm types I and II. J Vasc Surg 1996; 23: 223–8.[Web of Science][Medline]
2. Azizzadeh A, Huynh TT, Miller CC III, Safi HJ. Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: a case report and plea for a national database collection. J Vasc Surg 2000; 31: 592–8.[Medline]
3. Hill AB, Kalman PG, Johnston KW, Vosu HA. Reversal of delayed-onset paraplegia after thoracic aortic surgery with cerebrospinal fluid drainage. J Vasc Surg 1994; 20: 315–7.[Web of Science][Medline]
4. Khong B, Yang H, Doobay B, Skala R. Reversal of paraparesis after thoracic aneurysm repair by cerebrospinal fluid drainage. Can J Anaesth 2000; 47: 992–5.[Medline]

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