OBSERVATIONS ON DELAYED NEUROLOGIC DEFICIT AFTER THORACOABDOMINAL AORTIC-ANEURYSM REPAIR

Purpose: To describe the phenomenon of delayed-onset neurologic defici t after thoracoabdominal aortic aneurysm repair and to discuss managem ent of this type of deficit in a case series. Methods: Since September 1992 we have used cerebrospinal fluid drainage and distal aortic perf usion routinely to reduce the risk of neurologic deficit in thoracoabd ominal aortic aneurysm patients. All patent intercostal arteries were reattached when this was technically feasible. Delayed neurologic comp lications occurred in eight patients who underwent operation for thora coabdominal aortic aneurysm between September 1992 and March 1997, bet ween 1 and 14 days after awakening from anesthesia. All patients had i mmediate cerebrospinal fluid drainage on recognition of their symptoms . Results: Patients were evaluated by an independent neurologist and w ere classified by a modified Tarlov score between 0 and 5. All eight p atients improved at least two points by discharge. The mean change in Tarlov score from onset to discharge was 2.4 +/- 1.1 (p = 0.008). Conc lusions: Cerebrospinal fluid drainage significantly improved late-onse t neurologic deficit that occurred between 1 day and 2 weeks after ope ration in our series. Immediate drainage should be considered when sig ns of neurologic deficit first begin to appear.