Additionally, although the presence of dural ectasia does not contraindicate lumbar cerebrospinal fluid drainage for spinal cord protection during thoracoabdominal aortic aneurysm repair, a dural leak after drain removal may require epidural blood patching (J. Black, personal communication).
Dilated collateral vessel arising from the right posterior portal vein runs across the posterior surface of the liver, forms a venous aneurysm outside the liver, and drains into the IVC directly or through the adrenal vein [10, 11, 12].
The anatomic structure of the PAVM is classified according to the two types [ 4] defined as simple, with a single artery feeding into an aneurysmal communication with a single draining vein (Fig. 2, Movies 1 and 2), and complex, with two or more arterial branches communicating via an aneurysm with two or more draining veins (Fig. 3).
The use of other neuraxial monitors, specifically lumbar drains, are routinely employed in patients undergoing thoracoabdominal aneurysm repair, in which a high degree of systemic anticoagulation is necessary.
Patient underwent urgent surgery including insertion of external ventricular drain (EVD), right-sided craniectomy and clipping of the aneurysm at the same time.
Examination of his abdomen and drains did not indicate any leak from his recently repaired aneurysm.
The usefulness of the COPS protocol (CSF drainage to maintain a pressure of less than 5 mmHg without limit under CSF drain status/oxygen delivery/patient status) has been reported after delayed neurologic deficit in thoracoabdominal aortic aneurysm repair [10].
At this point CPB is stopped and blood is actively drained into the venous reservoir, rendering the operative field blood free and the aneurysm collapsed.
The aneurysm was resected and replaced by a Y-prosthesis, and the psoas abscess was drained.
Inclusion criteria were age ≥18 years and the clinical decision for either craniotomy to perform surgical ligation of an aneurysm, evacuation of a haematoma and/or decompression, or for an extended burr hole to place a ventricular drain or oxygen sensor.
