J Vasc Surg
Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada.
Published: July 2004
Objectives: We undertook a quantitative systematic review of randomized controlled trials (RCTs) and observational studies to determine the effectiveness of cerebrospinal fluid (CSF) drainage to prevent paraplegia in thoracic aneurysm (TA) and thoracoabdominal aortic aneurysm (TAAA) surgery.
Methods: We included RCTs and cohort studies that met the following criteria: elective or emergent aneurysm surgery involving the thoracic or thoracoabdominal aorta, documentation of postoperative neurologic deficits, and patient age older than 18 years. We excluded studies that reported results in 10 or fewer patients and duplicate publications. We identified eligible studies by searching computerized databases, our own files, and the reference lists of relevant articles and review articles. Database searching, eligibility decisions, relevance and method quality assessments, and data extraction were performed in duplicate with prespecified criteria.
Results: Of 372 publications identified in our search, 14 met our eligibility criteria. Three RCTs reported 289 patients with type I or type II TAAA. Lower limb neurologic deficits occurred in 12% of patients who underwent CSF drainage and 33% of control subjects (number needed to treat, 9; 95% confidence interval [CI], 5-50). The pooled odds ratio (OR) for development of paraplegia in patients in the CSF drainage group was 0.35 (P =.05; 95% CI, 0.12-0.99). Similar results were found in five cohort studies with a control group (pooled OR, 0.26; P =.0002; 95% CI, 0.13-0.53). When all studies were considered together the pooled OR of TA and TAAA was 0.3 (95% CI, 0.17-0.54). There was no statistical heterogeneity among studies included in the meta-analysis. In six cohort studies without a control group, the incidence of paraplegia in high-risk TA and TAAA was 7.6%.
Conclusions: Evidence from randomized and nonrandomized trials and from cohort studies support the use of CSF drainage as an adjunct to prevent paraplegia when this adjunct is used in centers with large experience in the management of TAAA.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.jvs.2004.03.017 | DOI Listing |
Mol Neurobiol
January 2025
Department of Pediatric Surgery, Division of Neurosurgery, McGovern Medical School at UTHealth, Houston, TX, USA.
Recently, it has been well-established that the glymphatic or glial-lymphatic system plays a vital role in the pathophysiology of various neurological compromise, especially hydrocephalus (HCP). Till now, the complete pathway is not yet fully understood, and little evidence is available from the literature that links hydrocephalus to disorders of the glymphatic system. Most published molecular studies and animal research have shown that, in models with hydrocephalus, the drainage of cerebrospinal fluid (CSF) via the glymphatic system is disrupted.
View Article and Find Full Text PDFJ Exp Med
February 2025
Brain Immunology and Glia (BIG) Center, Washington University in St. Louis, St. Louis, MO, USA.
Dysfunctional lymphatic drainage from the central nervous system (CNS) has been linked to neuroinflammatory and neurodegenerative disorders, but our understanding of the lymphatic contribution to CNS fluid autoregulation remains limited. Here, we studied forces that drive the outflow of the cerebrospinal fluid (CSF) into the deep and superficial cervical lymph nodes (dcLN and scLN) and tested how the blockade of lymphatic networks affects CNS fluid homeostasis. Outflow to the dcLN occurred spontaneously in the absence of lymphatic pumping and was coupled to intracranial pressure (ICP), whereas scLN drainage was driven by pumping.
View Article and Find Full Text PDFAntibiotics (Basel)
December 2024
Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy.
: The early identification of infection-causing microorganisms through multiplex PCR panels enables prompt and targeted antibiotic therapy. This study aimed to assess the performance of the BioFire Joint Infection Panel (BF-JIP) in analysing non-synovial fluid samples. : We conducted a retrospective cohort study at Trieste University Hospital, Italy, on hospitalised adults with non-synovial fluid samples tested by both BF-JIP and traditional culture methods (November 2022-April 2024).
View Article and Find Full Text PDFBrain Sci
December 2024
School of Mechanical Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
Background/objectives: Cerebrospinal infusion studies indicate that cerebrospinal fluid outflow resistance (R) is elevated in normal pressure hydrocephalus (NPH). These studies assume that the cerebrospinal formation rate (CSF) does not vary during the infusion. If the CSF were to increase during the infusion then the R would be overestimated.
View Article and Find Full Text PDFBrain Sci
December 2024
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!
© LitMetric 2025. All rights reserved.