Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

Yoshitani, Kenji; Kawaguchi, Masahiko; Kawamata, Mikito; Kakinohana, Manabu; Kato, Shinya; Hasuwa, Kyoko; Yamakage, Michiaki; Yoshikawa, Yusuke; Nishiwaki, Kimitoshi; Hasegawa, Kazuko; Inagaki, Yoshimi; Funaki, Kazumi; Matsumoto, Mishiya; Ishida, Kazuyoshi; Yamashita, Atsuo; Seo, Katsuhiro; Kakumoto, Shinichi; Tsubaki, Kosuke; Tanaka, Satoshi; Ishida, Takashi; Uchino, Haruto; Kakinuma, Takayasu; Yamada, Yosuke; Mori, Yoichi; Izumi, Shin-ichi; Shimizu, Jun; Furuichi, Yuko; Kin, Nobuhide; Uezono, Shoichi; Kida, Kotaro; Nishimura, Kunihiko; Nakai, Michikazu; Ohnishi, Yoshihiko

doi:10.1007/s00540-020-02857-w

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…The risk of SCI following TEVAR varies and depends primarily on the extent of coverage of the segmental arteries and the vigor of the paraspinal collateral network. Several risk factors predispose TEVAR patients to SCI [ 30 , 31 ]. These include severe calcification or extensive coverage of the descending thoracic aorta (≥ 20 cm long), coverage of the left subclavian artery without revascularization, coverage of the celiac artery, or occlusion of the hypogastric plexus.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Zheng,

Lin,

Cheng

et al. 2024

J Cardiothorac Surg

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Objective The aim of the present systematic review was to determine whether prophylactic use of cerebrospinal fluid drainage (CSFD) contributes to a lower rate of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched to identify all relevant studies reported before May 7, 2023. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42023441392). The primary outcome was permanent SCI. Secondary outcomes were temporary SCI and 30-day/in-hospital mortality. The data were presented as the pooled event rates (ERs) and 95% confidence intervals (CIs). Results A total of 1008 studies were screened, of which 34 studies with 2749 patients were included in the present analysis. The mean Downs and Black quality assessment score was 8.71 (range, 5–12). The pooled rate of permanent SCI with prophylactic CSFD was identical to that without prophylactic CSFD (2.0%; 95% CI, 1.0–3.0; P = 0.445). No statistically significant difference was found between the rates of permanent SCI with routine vs. selective prophylactic CSFD (P = 0.596). The pooled rate of temporary SCI was 1.0% (95% CI, 0.00–1.0%). The pooled rate for 30-day or in-hospital mortality was not significantly different (P = 0.525) in patients with prophylactic CSFD (4.0, 95% CI 2.0–6.0) or without prophylactic CSFD (5.0, 95% CI 2.0–7.0). Conclusions The systematic review has shown that prophylactic CSFD was not associated with a lower rate of permanent SCI and 30-day or in-hospital mortality after TEVAR for TBAD.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Zheng,

Lin,

Cheng

et al. 2024

J Cardiothorac Surg

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“…As early as 1986, Crawford et al reported that SCIR may result in paraplegia in up to 40% of the patients in thoracoabdominal surgery. [26] However, current methods to treat SCIR injuries are not yet effective, [27] including cerebrospinal fluid drainage, [28] reattachment of segmental arteries, [29] and administering pharmaceutical drugs (steroids, oxygen-derived free radical scavengers, and vasodilators). [30,31] The mechanism underlying SCIR-induced damage may be intricate.…”

Section: Discussionmentioning

confidence: 99%

Melatonin Exerts an Anti‐Panoptoic Role in Spinal Cord Ischemia‐Reperfusion Injured Rats

Xie,

Wu,

Shi

et al. 2023

Advanced Biology

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Paraplegia is a serious consequence of spinal cord ischemia‐reperfusion (SCIR) injury, which leads to neuron death and permanent loss of motor function. However, there is no effective treatment for SCIR. Melatonin exerts a neuroprotective effect in neurodegenerative diseases. However, whether pyroptosis, apoptosis, and necroptosis (PANoptosis) is the primary cause of the massive neural death in SCIR is unknown, and if melatonin exhibits anti‐PANoptotic effect in rescuing the disastrous damage is to be decided. This study indicates that melatonin confers neuroprotection in SCIR, attenuating the loss of Nissl body and improving Basso, Beattie & Bresnahan locomotor rating scale scores. Specifically, the apoptotic hallmarks in neurons are increased in SCIR injured spinal cord compared to the sham group. The upregulated trend is reversed by melatonin while the effect of melatonin is abolished by the administration of luzindole, a selective melatonin receptor antagonist. Moreover, similar patterns are found in the necroptotic markers in neurons, the pyroptotic indicators, and the interleukin‐1β staining in microglia. In conclusion, PANoptosis may underlie the mass neural death and paraplegia in SCIR, and melatonin confers neuroprotection to the spinal cord via inhibiting PANoptosis.

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Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study

et al. 2023

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Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

Cited by 6 publications

References 19 publications

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Melatonin Exerts an Anti‐Panoptoic Role in Spinal Cord Ischemia‐Reperfusion Injured Rats

Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study

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