EComment. Spinal cord protection during thoracoabdominal aneurysm repair

Abstract

The study ‘Novel application of acetazolamide to reduce cerebrospinal fluid production in patients undergoing thoracoabdominal aortic surgery’ by Jafarzadeh and associates [1] comes to cover a large practice gap in the prolepsis of spinal cord ischaemia in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair. Our practice so far is to protect the spinal cord during TAAA repair with a spinal drain that is kept for 48-72 h in the postoperative period. Strict guidelines are applied for the management of the drain for optimal protection. In addition, permissive hypothermia and liberal use of alpha-agonists in order to increase the mean arterial pressure during the postoperative period is the standard routine. Finally, recent studies have stressed that adding intrathecal papaverine to the neuroprotective protocol for descending thoracic aneurysm and TAAA repairs may enhance spinal cord perfusion and provide additional spinal cord protection [2]. We agree with the authors that in cases of contra-indication to the use of a spinal drain or the inability to insert it, the use of other agents that increase spinal cord perfusion is promising. There is an imperative need of a randomized trial, which will determine the efficacy of acetazolamide in the spinal cord protection during TAAA repair.