Objective: To systematically evaluate the efficacy and safety of cerebrospinal fluid drainage (CSFD) in prevention and treatment of spinal cord injury (paraplegia and paresis) after endovascular repair of thoracic-abdominal aortic aneurysm (TAAA).
Methods: The randomized controlled trials (RCTs) publicly published concerning CSFD for prevention and treatment of spinal cord injury after endovascular repair of TAAA were collected from several national and international databases by computer-based online and manual search. Systematic evaluation and Meta-analysis were performed by using RevMan 5.3 software.
Results: Five RCTs were included, involving 424 patients, of whom, 232 cases received CSFD treatment (CSFD group) and 192 patients did not receive CSFD treatment (control group). Results of Meta-analysis showed that the incidence of spinal cord injury in CSFD group was significantly lower than that in control group (OR=0.45, 95% CI=0.26–0.76, P=0.003); the overall mortality rate at the end of treatment and follow-up was lower in CSFD group than that in control group, but it did not reach a statistical significance (OR=0.67, 95% CI=0.31–1.44, P=0.31). Complications associated with CSFD therapy occurred in 6 cases in CSFD group and 0 cases in control group, but the difference in incidence of complications reached no statistical significance between the two groups (OR=4.38, 95% CI=0.75–25.49, P=0.10).
Conclusion: CSFD has a definite effect on prevention and treatment of spinal cord ischemia injury after endovascular repair for TAAA, but the quality of evidence and recommendation level are relatively low. There is still some controversy about the operative risk. CSFD is advisable for patients with high risk of paraplegia or those who already have presence of paraplegia. However, the risk-benefit ratio should be fully assessed and the operation should be cautiously performed for patients with low risk of paraplegia and complications such as bleeding.