Colle Arnaud, De Vloo Philippe, Mufty Hozan
Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
EJVES Vasc Forum. 2020 Aug 2;48:32-34. doi: 10.1016/j.ejvsvf.2020.07.030. eCollection 2020.
Spinal cord ischaemia (SCI) is a devastating complication of the treatment of thoraco-abdominal aneurysms. Peri-operative cerebrospinal fluid (CSF) drainage, typically using a spinal catheter, is a possible preventive measure. There are no reports or guidelines on peri-operative CSF drainage for this indication in patients with a ventriculoperitoneal (VP) shunt.
A single case of a patient suffering SCI after fenestrated endovascular aortic repair for the treatment of a pararenal aneurysm after previous open repair of an infrarenal aortic aneurysm is presented. Despite the presence of a patent VP shunt, elevated CSF pressures were observed after placement of a CSF drain.
A VP shunt with a gravitational component may drain insufficiently in bedridden patients who often lie with their head tilted on a cushion. In this position, both the differential pressure component and the gravitational component become active, thereby increasing the overall resistance to CSF outflow, hence increasing intracranial and intraspinal pressure. VP shunts with gravitational components should be managed with caution in the setting of prophylactic or therapeutic drainage of CSF to prevent SCI in extensive aortic repair. For reliable CSF pressure monitoring or active drainage in case of symptoms, the insertion of a spinal drain is indicated.
脊髓缺血（SCI）是胸腹主动脉瘤治疗中一种严重的并发症。围手术期脑脊液（CSF）引流，通常使用脊髓导管，是一种可能的预防措施。对于脑室腹腔（VP）分流患者的这种适应症，尚无围手术期CSF引流的报告或指南。
本文介绍了一例患者，该患者在先前进行肾下主动脉瘤开放修复术后，因开窗式血管内主动脉修复治疗肾旁动脉瘤而发生SCI。尽管VP分流管通畅，但放置CSF引流管后观察到CSF压力升高。
具有重力作用的VP分流管在经常头部靠在垫子上倾斜躺着的卧床患者中可能引流不足。在此位置，压差成分和重力成分均起作用，从而增加了CSF流出的总阻力，进而增加了颅内和脊髓内压力。在广泛的主动脉修复中，为预防SCI而进行CSF的预防性或治疗性引流时，应谨慎管理具有重力作用的VP分流管。为了进行可靠的CSF压力监测或在出现症状时进行主动引流，需要插入脊髓引流管。
