Ann Thorac Surg 1999;67:1544
© 1999 The Society of Thoracic Surgeons
Cerebrospinal fluid drainage
Shigeru Kazama, MDa
a Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan
To the Editor
I read with much interest the case report by Wildmann and colleagues in which a patient presenting delayed-onset paraplegia after thoracoabdominal aneurysm repair was successfully treated by cerebrospinal fluid (CSF) drainage . CSF drainage was shown to decrease the incidence of paraplegia after operations on the thoracic aorta for the first time in 1960 , but its real benefit in preventing and treating paraplegia associated with thoracoabdominal aneurysm repair has been repeatedly questioned . Several years ago, my colleagues and I undertook an experimental study to clarify the relationship between the CSF pressure (CSFP) and spinal cord blood flow (SCBF) . We found out that CSF drainage reduced the CSFP invariably, but did not increase SCBF at all when the CSFP was in the normal range at the beginning. We also found out that elevation of the CSFP significantly reduced SCBF, and in the setting of the elevated CSFP, CSF drainage restored SCBF. We therefore concluded that CSF drainage per se does not increase SCBF, but in circumstances when the CSFP is abnormally elevated, CSF drainage protects the spinal cord from ischemic injury by restoring SCBF. Although the elevated CSFP was not documented in Wildmann and colleagues case, the fact that paralysis and anesthesia disappeared immediately after CSF drainage can well be explained by our experimental data. I thank Dr Wildmann and colleagues for supplying this important information.
Wildmann M.D., DeLucia A., Sharp W.J., Richenbacher W.E. Reversal of renal failure and paraplegia after thoracoabdominal aneurysm repair. Ann Thorac Surg 1998;65:1153-1155.[Abstract/Free Full Text]
Miyamoto K., Ueno A., Wada T., Kimoto S. A new and simple method of preventing spinal cord damage following temporary occlusion of the thoracic aorta by draining the cerebrospinal fluid. J Cardiovasc Surg 1960;16:188-197.
Crawford E.S., Svensson L.G., Hess K.R., et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high risk surgery on the thoracoabdominal aorta. J Vasc Surg 1991;13:36-46.[Medline]
Kazama S., Masaki Y., Maruyama S., Ishihara A. Effect of altering cerebrospinal fluid pressure on spinal cord blood flow. Ann Thorac Surg 1994;58:112-115.[Abstract/Free Full Text]