Meningeal haemorrhage secondary to cerebrospinal fluid drainage during thoracic endovascular aortic repair

Abstract

Thoracic endovascular aortic repair (TEVAR) has shown lower mortality compared with open surgical repair (OSR). However, the risk of spinal cord ischaemia (SCI) remains similar than OSR. As a prophylactic measure to reduce the risk of SCI, cerebrospinal fluid (CSF) drainage has been widely used in OSR. In TEVAR, the utility of this adjunct is still controversial. We report a case of a 56-year-old man referred for TEVAR for a descending thoracic aneurysm that previously underwent an abdominal aneurysmectomy with aortobifemoral bypass graft. On the day before, a lumbar cerebrospinal drain was placed prophylactically. Forty-eight hours after the procedure, meningeal symptoms without neurological deficits developed. Clinical investigation revealed meningeal haemorrhage. Therapy with nimodipine was initiated with symptomatic relief. Evidence from randomized controlled trials supporting the role of CSF drainage in TEVAR is still lacking. We discuss the current recommendations, potential benefits and risks and cautions associated with CSF drainage in TEVAR.

Postendovascular thoracic aortic repair subclavian steal syndrome revealed by severe headache

“…Our patient presented with a severe headache, although mentioned in the literature as possible presentation in SCSS [11], we did not find any reported similar case mentioning the headache as the only sign post-TEVAR and reflecting the coverage of left SCA. The headache is reported to be a sign of meningeal hemorrhage following cerebro-spinal fluid (CSF) drainage during TEVAR [12]. In fact the drainage of CSF is used by many teams to reduce the risk of SCI and related paraplegia [13].…”

Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

“…Acute symptomatic hydrocephalus in SAH 12 Spinal cord-protective strategy in open and endovascular thoracic aortic repair for patients at high risk of spinal cord injury 9,24,[38][39][40] Active CSF leak (due to craniofacial trauma) 41 or those at risk for CSF leak during skull base procedures [42][43][44] ; however, lumbar drains do not prevent postoperative CSF leaks 44,45 Facilitate intraoperative brain relaxation 27 and intraoperative exposure 46 CSF indicates cerebrospinal fluid; CT, computed tomography; GCS, Glasgow Coma Score; ICH, intracerebral hemorrhage; IVH, intraventricular hemorrhage; rTPA, recombinant tissue plasminogen activator; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; TBI, traumatic brain injury.…”