2019 Volume 39 Issue 5 Pages 510-515
An 80-year-old woman was scheduled for total aortic arch replacement and thoracic endovascular aortic repair（TEVAR）to repair chronic type B aortic dissection with thrombosed false lumen. Cerebrospinal fluid drainage（CSFD）was inserted without difficulty before general anesthesia for TEVAR because of high risk of spinal cord ischemia. The cerebrospinal fluid was transparent at the start of drainage and became bloody after systemic heparinization temporarily during surgery. On postoperative day 2, CSFD was removed. At that time, coagulation studies were within the normal range but platelet count was 48,000 per microliter. That night, leg and low back pain occurred and became progressively worse. Paraplegia occurred on postoperative day 4, and magnetic resonance imaging examination of lumbar spine demonstrated hematoma compressing the cauda equine, so she was taken for emergency laminectomy. Almost all of the hematoma was in the subdural space. After the surgery, paraplegia gradually improved.
