Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

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


Issue's catalogue ➤ КФК. 2025; 22 (3): 199-286 ➤ Новые подходы к дренированию спинномозговой жидкости при операциях на аорте

Cerebral spinal fluid drainage protocol in aortic surgery

Authors: Shchanitsyn I.N., Arakelyan V.S., Papitashvili V.G., Gamzaev N.R., Khinchagov D.Ya., Khon V.L., Chshieva I.V., Gvazava M.D.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2025-22-3-274-285

UDC: 616.132+616-003.282]-089

Link: Clinical Physiology of Blood Circulaiton. 2025; 22 (3): 274-285

Quote as: Shchanitsyn I.N., Arakelyan V.S., Papitashvili V.G., Gamzaev N.R., Khinchagov D.Ya., Khon V.L., Chshie- va I.V., Gvazava M.D. Cerebral spinal fluid drainage protocol in aortic surgery. Clinical Physiology of Сirculation. 2025; 22 (3): 274–285 (in Russ.). DOI: 10.24022/1814-6910-2025-22-3-274-285

Keywords:  thoracoabdominal aortic aneurysm cerebrospinal fluid cerebrospinal fluid drainage complications intracranial hemorrhage

Received / Accepted:  17.07.2025 / 09.09.2025

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Abstract

The incidence of spinal complications (lower paraplegia, paraparesis, dysfunction of the pelvic organs) in surgeries for aneurysms of the thoracic and thoracoabdominal aorta remains high. Drainage of cerebrospinal fluid in case of increased spinal pressure is recommended as the main method of preventing spinal cord ischemia. At the A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, this method has been routinely used for over 25 years in cases of high risk of spinal complications. Since 2017, a method of automatic CSF drainage using the LiquoGuard device has been introduced. We encountered severe complications, such as subdural hematoma. This led us to the need to analyze existing studies and our own results to create a bladeless and effective CSF drainage protocol.

Material and methods. We performed a retrospective analysis of the treatment outcomes of patients with thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) from 2000 to 2024, who underwent CSF pressure monitoring and drainage. The study included 331 patients. The diagnosis of AAA was 168 (50,8%), type I TAAA – 34 (10,3%), type II TAAA – 61 (18,4%), type III TAAA – 47 (14,2%), type IV TAAA – 21 (6,3%). CSF drainage was performed when the cerebrospinal pressure increased by more than 10–12 mm Hg intraoperatively and in the postoperative period by two methods: passive manual drainage (232 patients) and automatic drainage (LiquoGuard) without limiting the drainage volume (99 patients). The incidence of spinal complications, the incidence of CSF drainage complications, and mortality associated with CSF drainage were assessed.

Results. The overall incidence of spinal complications was 8,5%. Complications of CSF drainage were observed in 11,2% of cases, severe complications (symptomatic subdural hematoma and intracerebral hemorrhage) – in 2.7%. Mortality associated with complications of CSF drainage was 2.4%. To compare drainage methods, we performed pseudo-randomization, taking into account the initial heterogeneity of the groups. As a result of the comparison, it turned out that the median of the total volume of drained CSF was significantly higher in the LiquoGuard group, 94 ml (IQR 59–124 ml) compared to the passive drainage group – 24 ml (IQR 12–35). Spinal ischemia and post-puncture headaches were more often observed in the passive group, and intracranial hemorrhage – in the automatic drainage group. Based on the literature review and our own experience, we developed a detailed protocol for CSF drainage with an algorithm for the prevention and treatment of various complications. It was based on the selective use of CSF drainage and limitation of the drainage volume.

Conclusion. CSF drainage remains the main method of prevention and treatment of spinal cord ischemia in operations for TAAA, since the risk of spinal ischemia significantly exceeds the risk of developing severe complications of drainage. It is necessary to weigh the potential benefits and risks of using CSF drainage. Further studies are needed to evaluate the developed protocol of CSF drainage with limitation of drainage volume.

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****
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About Authors

  • Ivan N. Shchanitsyn, Cand. Med. Sci., Researcher, Cardiovascular Surgeon; ORCID
  • Valery S. Arakelyan, Dr. Med. Sci., Professor of the Department, Head of the Department of Arterial Pathology (DAP), Cardiovascular Surgeon; ORCID
  • Vasil G. Papitashvili, Dr. Med. Sci., Cardiovascular Surgeon; ORCID
  • Nazim R. Gamzaev, Cardiovascular Surgeon; ORCID
  • Dzhumber Ya. Khinchagov, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Vladislav L. Khon, Cardiovascular Surgeon; ORCID
  • Inna V. Chshieva, Cand. Med. Sci., Researcher, Cardiovascular Surgeon; ORCID
  • Mariami D. Gvazava, Resident Physician; ORCID

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