• Hiroki Mitsuoka, Yuki Orimoto, Makiyo Hagihara, Kojiro Suzuki, Takahiro Arima, Taiki Isaji, Masakazu Takayasu, and Hiroyuki Ishibashi.
• Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan. Electronic address: hiroki.m.i@aichi-med-u.ac.jp.
• World Neurosurg. 2020 Jul 1; 139: 440-444.

BackgroundCerebrospinal fluid (CSF) drainage during the treatment of aortic disease is commonly performed to prevent spinal cord ischemia. Spinal subdural hematoma (SDH) has never been reported after CSF drainage during thoracic endovascular aortic repair (TEVAR). We present a case of concurrent intracranial subarachnoid hemorrhage (SAH) and spinal SDH after CSF drainage tube removal in a patient with TEVAR.Case DescriptionA 73-year-old man was hospitalized to undergo TEVAR. The day before the procedure, a lumbar CSF drainage tube was inserted. Continuous CSF drainage was performed only during the procedure, and the tube was removed the following day. The patient complained of mild back pain on postoperative day 2; headache, bilateral lower limb paresis, and bladder and rectal disturbances developed on postoperative day 5. Brain and spinal magnetic resonance imaging revealed spinal subdural or subarachnoid hematoma and intracranial SAH. Lumbar laminectomies for spinal SDH removal were performed; lower limb strength improved immediately after surgery. At postoperative 2 years, the patient returned to his preoperative activity level; only mild right lower limb numbness persisted.ConclusionsWe present a rare case of intracranial SAH and spinal SDH that developed after CSF drainage tube removal in a patient with TEVAR. CSF drainage should be carefully considered in patients undergoing aortic procedures, as SAH and spinal SDH may occur in addition to spinal cord ischemia.Copyright © 2020 Elsevier Inc. All rights reserved.

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