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

Abstract

This study aimed to review a 10-year experience, identify cerebrospinal fluid drainage (CSFD)-related complications, and evaluate its usefulness in spinal cord protection. 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. 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%). Open DTA/TAAA repairs with CSFD showed acceptable outcomes. Although minor complications were relatively frequent, major complications were rare at this experienced center.