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Kontinuierliche kontrollierte lumbale Liquordrainage zur Prävention der spinalen Ischämie bei thorakoabdominaler Aortenchirurgie

Continuous controlled lumbar spinal fluid drainage for prevention of spinal ischemia during thoracoabdominal surgery of the aorta

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Zusammenfassung

Die spinale Ischämie ist ein Problem in der thorakoabdominalen Aortenchirurgie. In der Folge entwickeln sich neurologische Ausfälle wie sensorische Defizite, aber auch Paraparesen und Paraplegien. Deshalb bleibt die Protektion des Rückenmarks während thorakoabdominaler Aortenrekonstruktionen eine wichtige Aufgabe. Das am häufigsten verwendete neurologische Monitoring ist die Messung des Liquordrucks im lumbalen Spinalkanal und die spinale Flüssigkeitsdrainage. Klinische oder technische Komplikationen wie Meningitiden oder Katheterbrüche sind nicht selten durch die häufigen und intermittierenden Liquorentnahmen am Tropfkammersystem bedingt. Weitere Komplikationen sind intraspinale Hämatome und intrakranielle subdurale Hämatome bei exzessiver manueller Drainage. Bei den bisher durchgeführten Lumbaldrainagen handelte es sich um manuell durchgeführte unregelmäßige Drainagen. Unter Einbindung des LiquoGuards der Firma Möller Medical GmbH konnte erstmals ein kontinuierlicher druckgesteuerter Liquorabfluss ermöglicht werden. Ferner handelt es sich im Gegensatz zu den bekannten Tropfkammersystemen um ein geschlossenes steriles Drainageverfahren.

Abstract

Spinal ischemia is an unresolved problem in thoracoabdominal surgery of the aorta. As a result, neurological failures such as sensory deficits occur, as well as paraparesis and paraplegia. Therefore, protection of the spinal cord during thoracoabdominal surgery is a major challenge. The most commonly used method of neurologic surveillance is measurement of spinal fluid drainage and cerebrospinal pressure in the lumbar spinal canal. Complications such as meningitis or spinal catheter fracture can be caused by intermittent fluid withdrawal in the drop-chamber system. Further complications include intraspinal hematoma and intracranial subdural hematoma due to excessive manual drainage. So far, cerebrospinal fluid drainage systems have been manual and unbalanced. Using LiquoGuard (Möller Medical), continuous pressure-controlled cerebrospinal fluid drainage has been enabled for the first time. Furthermore, this drainage system is closed and sterile, in contrast to established drop-chamber systems.

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Literatur

  1. Afifi S (2002) Pro: cerebrospinal fluid drainage protects the spinal cord during thoracoabdominal aortic reconstruction surgery. J Cardiothorac Vasc Anesth 16:643–649

    Article  PubMed  Google Scholar 

  2. Bergeron P, De Chaumaray T, Gay J, Douillez V (2003) Endovascular treatment of thoracic aortic aneurysms. J Cardiovasc Surg (Torino) 44:349–361

    Google Scholar 

  3. Blaisdell FW, Cooley DA (1962) The mechanism of paraplegia after temporary thoracic aortic occlusion and its relationship to spinal fluid pressure. Surgery 51:351–355

    CAS  PubMed  Google Scholar 

  4. Cambria RP, Davison JK, Carter C et al (2000) Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: A five-year experience. J Vasc Surg 31:1093–1102

    CAS  PubMed  Google Scholar 

  5. Cheung AT, Pochettino A, Guvakov DV et al (2003) Safety of lumbar drains in thoracic aortic operations performed with extracorporeal circulation. Ann Thorac Surg 76:1190–1196, discussion 1196–1197

    Article  PubMed  Google Scholar 

  6. Coselli JS, Lemaire SA, Koksoy C et al (2002) Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg 35:631–639

    Article  PubMed  Google Scholar 

  7. Coselli JS, LeMaire SA, Miller CC 3rd et al (2000) Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: a risk factor analysis. Ann Thorac Surg 69:409–414

    Article  CAS  PubMed  Google Scholar 

  8. Crawford E, Svensson L, Hess K et al (1991) A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 13:36–46

    Article  CAS  PubMed  Google Scholar 

  9. Griepp RB, Ergin MA, Galla JD et al (1996) Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg 112:1202–1213, discussion 1213–1205

    Article  CAS  PubMed  Google Scholar 

  10. Heller LB, Chaney MA (2001) Paraplegia immediately following removal of a cerebrospinal fluid drainage catheter in a patient after thoracoabdominal aortic aneurysm surgery. Anesthesiology 95:1285–1287

    Article  CAS  PubMed  Google Scholar 

  11. Hollier LH, Money SR, Naslund TC et al (1992) Risk of spinal cord dysfunction in patients undergoing thoracoabdominal aortic replacement. Am J Surg 164:210–213, Discussion 213–214

    Article  CAS  PubMed  Google Scholar 

  12. Hollier LH, Moore WM (1990) Avoidance of renal and neurologic complications following thoracoabdominal aortic aneurysm repair. Acta Chir Scand Suppl 555:129–135

    CAS  PubMed  Google Scholar 

  13. Jacobs TP, Kempski O, McKinley D et al (1992) Blood flow and vascular permeability during motor dysfunction in a rabbit model of spinal cord ischemia. Stroke 23:367–373

    CAS  PubMed  Google Scholar 

  14. LeMaire SA, Miller CC 3rd, Conklin LD et al (2003) Estimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann thorac Surg 75:508–513

    Article  PubMed  Google Scholar 

  15. McHardy FE, Bayly PJ, Wyatt MG (2001) Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoracoabdominal aneurysm. Anaesthesia 56:168–170

    Article  CAS  PubMed  Google Scholar 

  16. Miyamoto K, Ueno A, Wada T (1960) A new and simple method of preventing spinal cord damage following temporary occlusion of thoracic aorta by drainage the cerebrospinal fluid. J Cardiovasc Surg (Torino) 1188–1197

  17. Safi HJ, Miller CC 3rd (1999) Spinal cord protection in descending thoracic and thoracoabdominal aortic repair. Ann Thorac Surg 67:1937–1939, discussion 1953–1938

    Article  CAS  PubMed  Google Scholar 

  18. Svensson LG, Crawford ES, Hess KR et al (1993) Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17:357–368, discussion 368–370

    Article  CAS  PubMed  Google Scholar 

  19. Svensson LG, Hess KR, D’Agostino RS et al (1998) Reduction of neurologic injury after high-risk thoracoabdominal aortic operation. Ann Thorac Surg 66:132–138

    Article  CAS  PubMed  Google Scholar 

  20. Weaver K, Wiseman D, Farber M et al (2001) Complications of lumbar drainage after thoracoabdominal aortic aneurysm repair. J Vasc Surg 34:623–627

    Article  CAS  PubMed  Google Scholar 

  21. Wolf O, Böckler D, Heider P et al (2007) Hybridverfahren zur Therapie thorakoabdomineller Aortenaneurysmen. Gefässchirurgie 12:435–439

    Article  Google Scholar 

  22. Wynn MM, Mell MW, Tefera G et al (n d) Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008

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Authors and Affiliations

  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland

    N. Klemz, P. Köster & E. Berendes

  2. Klinik für Gefäßchirurgie – vaskuläre und endovaskuläre Chirurgie, HELIOS Klinikum Krefeld, Krefeld, Deutschland

    B. Luther & T. Nowak

Authors
  1. N. Klemz
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  2. B. Luther
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  3. P. Köster
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  4. T. Nowak
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  5. E. Berendes
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Correspondence to N. Klemz.

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Klemz, N., Luther, B., Köster, P. et al. Kontinuierliche kontrollierte lumbale Liquordrainage zur Prävention der spinalen Ischämie bei thorakoabdominaler Aortenchirurgie. Gefässchirurgie 15, 113–116 (2010). https://doi.org/10.1007/s00772-009-0704-2

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