Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Algorithm for complications of cerebrospinal fluid drainage during aortic surgery

Authors: Shchanitsyn I.N., Arakelyan V.S., Papitashvili V.G., Averina T.B., Bondarev A.M., Bukatsello R.G., Kulichkov P.P., Andronatiy V.A.

DOI: https://doi.org/10.24022/1814-6910-2025-22-3-222-235

UDC: 616.13-004.6-089

Link: Clinical Physiology of Blood Circulaiton. 2025; 22 (3): 222-235

Quote as: Shchanitsyn I.N., Arakelyan V.S., Papitashvili V.G., Averina T.B., Bondarev A.M., Bukatsello R.G., Kulichkov P.P., Andronatiy V.A. Algorithm for complications of cerebrospinal fluid drainage during aortic surgery. Clinical Physiology of Сirculation. 2025; 22 (3): 223–235 (in Russ.). DOI: 10.24022/1814-6910-2025-22-3-222-235

Received / Accepted:  01.09.2025 / 15.09.2025

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Abstract

Currently, prophylactic CSF drainage is recommended for patients with high risk of spinal cord ischemia in open and endovascular operations on the thoracic aorta. However, in recent years, there has been an increase in the number of publications describing severe complications of CSF drainage, such as subdural hematoma or intracerebral hemorrhage. The incidence of all complications in some studies reaches 10%. The purpose of this work was to analyze existing studies and our own experience to create an algorithm of actions in the event of various complications of CSF drainage.

Methods. We reviewed the literature on complications of CSF drainage in aortic surgeries. Complications were classified by severity, and the average incidence of complications was determined based on literature data. We analyzed our own treatment outcomes for patients with thoracic aortic aneurysms (TAAA) and thoracoabdominal aortic aneurysms (TAAA) from 2000 to 2024, who underwent CSF pressure monitoring and drainage. The retrospective study included 331 patients diagnosed with AAA (50.8%) and TAAA (49.2%). We assessed the incidence of CSF drainage complications and CSF drainage-related mortality.

Results. In a retrospective study, complications of CSF drainage were detected in 11.2% of cases. According to severity, the division was as follows: mild in 5.1% (moderate post-dural puncture headaches (PDPH)), moderate in 3.3% (severe PDPH – 1.8%, asymptomatic intracerebral hemorrhage – 1.2%, signs of paralumbar infection – 0.3%), severe in 2.7% (symptomatic subdural hematoma – 1.2%, intracerebral hemorrhage – 1.5%). Difficulties in placing spinal drainage were found in 2.1%. Blood in the CSF was detected in 1.5% of patients. Mortality associated with complications of CSF drainage was 2.4%. Severe complications (symptomatic subdural hematoma and intracerebral hemorrhage) were detected in 2.7%. Mortality associated with complications of CSF drainage was 2.4%. When compared with literature data, severe complications did not differ, but the overall frequency of complications was higher, primarily due to mild complications. Based on literature data and our own experience, we developed a detailed algorithm of actions in the event of various complications of CSF drainage.

Conclusion. Although CSF drainage remains the main method of preventing and treating spinal cord ischemia in TAAA surgeries, it is necessary to evaluate the potential risks and benefits of drainage. An algorithm of actions in the event of various complications of CSF drainage will reduce the incidence of adverse outcomes in aortic surgeries.


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