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Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
[Complications of cerebrospinal fluid drainage after thoracoabdominal aortic surgery (systematic review and
I N Shchanitsyn1, V S Arakelyan1, V G Papitashvili1
1Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 119049, Moscow, Russian Federation.
Insights
Cerebrospinal fluid (CSF) drainage is a key method for spinal cord protection during aortic aneurysm surgery, but it carries significant risks. This study found an 11.9% complication rate, including intracranial hemorrhage, necessitating careful risk-benefit assessment.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Medical Complications
Background:
- Cerebrospinal fluid (CSF) drainage is the sole Level 1 evidence spinal cord protection method for thoracoabdominal aortic aneurysm (TAAA) surgery.
- Concerns regarding CSF drainage complications, such as intracranial hemorrhage, have grown.
- This study addresses the frequency and risk factors of CSF drainage complications in TAAA operations.
Purpose of the Study:
- To determine the frequency of complications associated with cerebrospinal fluid (CSF) drainage during thoracoabdominal aortic aneurysm (TAAA) surgery.
- To identify risk factors influencing the complication rate of CSF drainage.
- To evaluate the methodological quality and heterogeneity of existing studies on CSF drainage complications.
Main Methods:
- A systematic literature search was conducted across PubMed, Google Scholar, and eLibrary databases following PRISMA guidelines.
- Methodological quality was assessed using ROBINS1 and ROBINS2 scales.
- A meta-analysis using a random-effects model calculated pooled complication rates, with meta-regression analyzing influencing factors.
Main Results:
- Analysis of 71 articles (10,798 patients) revealed an overall complication rate of 11.9% for CSF drainage.
- Severe complications occurred in 1.7%, symptomatic intracranial hemorrhage in 1.3%, and associated mortality in 1.1%.
- Later publications showed a significant increase in complications, with no differences based on study type, surgical approach, or drainage parameters.
Conclusions:
- The high complication rate necessitates a thorough risk-benefit assessment of CSF drainage.
- Existing data limitations and the high prevalence of complications underscore the need for further research.
- Future studies should aim to accurately determine complication rates and evaluate optimal CSF drainage protocols.
Relevance:
Currently, only one method of spinal cord protection-cerebrospinal fluid (CSF) drainage - has been rated as level 1 evidence in international guidelines for thoracoabdominal aortic aneurysm surgery. However, in recent years, there has been increased attention to complications of CSF drainage, such as intracranial hemorrhage. The aim determination of the frequency and risk factors of complications of CSF drainage during operations for thoracoabdominal aortic aneurysms.
Material And Methods:
A search of publications in the PubMed (Medline), Google Scholar, and Russian Science Citation Index (eLibrary) databases was conducted according to the PRISMA criteria. The ROBINS1 and ROBINS2 scales were used to assess the methodological quality of the studies. The pooled complication rate was calculated using a random-effects model (DerSimonian-Laird). Univariate (subgroup analysis) and meta-regression analyses were performed to assess the influence of the following parameters on the complication rate of CSF drainage: study type, article publication date, surgical approach, target CSF threshold pressure, CSF drainage rate, and CSF drainage method.
Results:
The final analysis included 71 articles (10.798 patients) published from 1991 to 2024. In general, the methodological quality of the studies was acceptable, the risk of systematic error remained moderate. According to the meta-analysis, the incidence of all complications of CSF drainage was 11.9% (95% CI 9.7-14.1), the incidence of severe complications was 1.7% (95% CI 1.3-2.0), intracranial symptomatic hemorrhage was 1.3% (95% CI 1.0-1.7), and associated mortality was 1.1% (95% CI 0.1-3.1). High heterogeneity of studies and the absence of significant publication bias were noted. A significant increase in the incidence of complications was revealed in later publications. No differences were found in the incidence of CSF drainage complications depending on the type of publication, type of procedure, CSF pressure threshold used, drainage rate, and drainage technique.
Conclusion:
Due to the high complication rate, a careful assessment of the benefits and risks of CSF drainage is necessary. This study highlights the limitations of the available data, the high prevalence of complications associated with CSF drainage, and the need for further research to determine the true complication rate and evaluate various CSF drainage protocols.
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