Ohashi Yuko, Washiyama Naoki, Takahashi Daisuke, Tsuda Kazumasa, Hirano Masahiro, Shiiya Norihiko
First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
Department of Cardiovascular Surgery, NHO Hakodate Medical Center, 18-16 Kawaharacho, Hakodate, 041-8512, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun;73(6):411-419. doi: 10.1007/s11748-024-02085-z. Epub 2024 Sep 26.
Although cerebrospinal fluid drainage has been shown to reduce the risk of ischemic spinal cord injury, serious complications have also been reported. We have been using it selectively in a pressure- and volume-regulated method and aimed to evaluate its safety, and its validity in elective thoracic endovascular aortic repair in a propensity-matched cohort.
Among the 450 patients who underwent open surgery (n = 169) or thoracic endovascular aortic repair (n = 281) on the descending or thoracoabdominal aorta, 147 underwent cerebrospinal fluid drainage, which was prophylactic in 135 and therapeutic in 12. Prophylactic drainage was performed in elective open surgery under distal aortic perfusion (n = 67) or in selected patients undergoing thoracic endovascular aortic repair (n = 68).
Drainage-related complications were observed in 13 (9.6%), one of which was graded severe (0.74%). In patients undergoing prophylactic drainage, spinal cord injury was detected in 2/135 (1.5%). In patients without prophylactic drainage, 15/315 (4.8%) developed spinal cord injury. Therapeutic drainage was performed in 12 of these 15 patients, 10 of whom remained paralytic in varying degree. In the inverse probability weighted analysis of the patients undergoing elective thoracic endovascular aortic repair, the incidence of spinal cord injury was lower with prophylactic drainage (p = 0.028).
Pressure- and volume-regulated spinal drainage rarely causes serious complications. Its prophylactic use seems beneficial in selected patients, including those undergoing thoracic endovascular aortic repair with high risk for spinal cord injury.
尽管脑脊液引流已被证明可降低缺血性脊髓损伤的风险，但也有严重并发症的报道。我们一直在采用压力和容量调节的方法选择性地使用脑脊液引流，并旨在评估其安全性以及在倾向匹配队列中的择期胸段血管腔内主动脉修复中的有效性。
在450例行降主动脉或胸腹主动脉开放手术（n = 169）或胸段血管腔内主动脉修复术（n = 281）的患者中，147例行脑脊液引流，其中135例为预防性引流，12例为治疗性引流。预防性引流在远端主动脉灌注下的择期开放手术中进行（n = 67）或在选定的胸段血管腔内主动脉修复患者中进行（n = 68）。
观察到13例（9.6%）与引流相关的并发症，其中1例为严重分级（0.74%）。在接受预防性引流的患者中，2/135（1.5%）检测到脊髓损伤。在未进行预防性引流的患者中，15/315（4.8%）发生脊髓损伤。这15例患者中有12例进行了治疗性引流，其中10例仍有不同程度的瘫痪。在对择期胸段血管腔内主动脉修复患者的逆概率加权分析中，预防性引流的脊髓损伤发生率较低（p = 0.028）。
压力和容量调节的脊髓引流很少引起严重并发症。其预防性使用在选定的患者中似乎有益，包括那些脊髓损伤风险高的胸段血管腔内主动脉修复患者。
