Descending thoracic and thoracoabdominal aneurysm repair continue to be complicated by postoperative paraplegia. We provide a review of regional spinal cord cooling and cerebrospinal fluid (CSF) drainage literature, as well as a retrospective review in our hospital over the past three years.
Articles for review of literature were obtained via a medline search for “thoracic aorta aneurysm repair” and “thoracoabdominal aneurysm repair”. The experiences of one anesthesiologist, who routinely employs CSF drainage and regional spinal cord cooling, were reviewed retrospectively. 20 consecutive thoracoabdominal aneurysm repairs from 1998 to 2001 were included. Cases were analyzed for neurologic complications and mortality up until discharge. Other monitored parameters include; intraoperative CSF pressures, CSF cooling temperature, total CSF drained, and aortic clamp time.
Incidence of paraplegia was 10% and mortality was 5%. Mean clamp time was 59 minutes. Mean CSF drained prior to removal of the Codman Drain was 313cc. Both cases of paraplegia were elective surgeries. The single fatality had good neurologic function post operatively but later developed acute renal failure and ARDS. Operative characteristics are included below:Average CSF Drained313ccTotal CSF Drained Range20 – 575 ccAverage Aortic Clamp Time59 minutesClamp Time Range28 minutes – 115 minutesAverage CSF Operative Temperature30.3 °CAverage Trough CSF Operative Temperature26.3 °CTrough CSF Temperature Range24.5 °C – 28 °CAverage CSF Operative Pressure33.6 mm HgCSF Operative Pressure Range12 mm Hg – 61 mm HgDISCUSSION: Svensson et al. published a large retrospective review of thoracoabdominal aneurysm repairs in 1993. Distal aortic perfusion was employed in 17% of this population and intercostal artery reanastomosis was performed in 45%. The incidence of paraplegia and paralysis was 16% and the 30-day mortality was 8% (1). Our data is comparable to these statistics; however, we employed multiple spinal cord protection techniques that were not used by Svensson. Further statistical analysis of paralysis and mortality rates prior to the use of spinal cord cooling and CSF drainage in this institution are needed to decide whether these techniques had a beneficial impact on this population.
A. Dhupa, None.