Preoperative and postoperative complications of cerebrospinal fluid drainage in descending thoracic and thoraco-abdominal aortic aneurysm surgery: a single center retrospective study.
Preoperative and postoperative complications of cerebrospinal fluid drainage in descending thoracic and thoraco-abdominal aortic aneurysm surgery: a single center retrospective study.
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胸降段和胸腹主动脉瘤手术脑脊液引流术前术后并发症：单中心回顾性研究。
DOI：
10.1007/s00540-022-03077-0
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发表时间：
2022
期刊：
影响因子：
2.8
通讯作者：
Kawamata M
中科院分区：
文献类型：
--
作者：
Sugiyama Y;Fuseya S;Aiba K;Maruyama Y;Shimao T;Tanaka S;Kawamata M
目的脑脊液引流（CSFD）用于预防胸降主动脉或胸腹主动脉瘤（DTA/TAAA）手术中的截瘫；然而，CSFD 本身存在严重并发症的风险。我们回顾性调查CSFD相关术前及术后并发症的发生率。方法纳入术前一天插入CSFD导管而接受DTA/TAAA手术的患者。将脊柱穿刺至DTA/TAAA手术期间的并发症发生率作为术前CSFD并发症进行调查，将DTA/TAAA手术至术后第7天期间的并发症发生率作为CSFD相关术后并发症进行调查。结果对123例患者术前CSFD并发症进行分析。由于脑脊液血（2.5%）和脑膜炎（1.7%），DTA/TAAA 手术被推迟。术前轻度并发症发生率为32.4%。对108例CSFD术后并发症进行分析。开放手术中3.9%的病例发生颅内出血，术后未出现其他严重CSFD并发症。开放手术中、轻度并发症的发生率为2.6%/14.3%，TEVAR中为3.2%/19.4%。结论血性脑脊液和脑膜炎是脊柱穿刺相关的严重并发症，发生在脊柱穿刺后1 d内。术前和术后中、轻度并发症发生率均较高。这些结果表明，CSFD 导管插入和管理应谨慎进行，同时考虑到 CSFD 的风险和益处。
PurposeCerebrospinal-fluid drainage (CSFD) has been performed to prevent paraplegia in descending thoracic or thoraco-abdominal aortic aneurysm (DTA/TAAA) surgery; however, CSFD itself has a risk of severe complications. We retrospectively investigated the incidence rates of CSFD-related preoperative and postoperative complications.MethodsPatients who underwent DTA/TAAA surgery with a CSFD catheter that was inserted on the day before surgery were enrolled. The incidence rates of complications from spinal puncture until DTA/TAAA surgery were investigated as preoperative CSFD complications, and the incidence rates from DTA/TAAA surgery to postoperative day 7 were investigated as CSFD-related postoperative complications.ResultsPreoperative CSFD complications were analyzed in 123 cases. DTA/TAAA surgery was postponed due to bloody cerebrospinal fluid (2.5%) and due to meningitis (1.7%). The incidence rate of mild preoperative complications was 32.4%. Postoperative CSFD complications were analyzed in 108 cases. Intracranial hemorrhage occurred in 3.9% of cases in open surgery and other postoperative severe CSFD complications did not occur. The incidence rates of moderate/mild complications in open surgery were 2.6%/14.3% and those in TEVAR were 3.2%/19.4%.ConclusionBloody cerebrospinal fluid and meningitis, which are severe complications associated with spinal puncture, occurred within 1 day after spinal puncture. The incidence rates of moderate/mild complications were high in both the preoperative and postoperative periods. These results showed that CSFD catheter insertion and management should be performed carefully with consideration given to the risks and benefits of CSFD.