Post-dural puncture headaches following spinal drain placement during thoracoabdominal aortic aneurysm repair: incidence, associated risk factors, and treatment.

PURPOSE: Spinal drains are used as a neuroprotective measure during thoracoabdominal aortic aneurysm (TAA) repair. Unfortunately, these drains can cause post-dural puncture headaches (PDPH). While PDPH following spinal anesthesia have been thoroughly evaluated, limited data exists about the incidence and risk factors for PDPH following spinal drains. Additionally, the efficacy of treatment with conservative therapies and epidural blood patches (EBP) for PDPH secondary to spinal drains has not been well documented.

METHODS: Data on 235 patients receiving spinal drains for scheduled TAA repair and surviving to discharge between January, 2005 and July, 2012 at the University of Wisconsin Hospitals and Clinics were retrospectively reviewed. The following data were extracted from the patient medical record: patient demographics, pre-existing medical conditions, spinal drain details, PDPH presentation, PDPH treatment methods, and success of treatments used. This data was then analyzed for statistical significance.

RESULTS: Of 235 patients, 43 (18.3 %) developed PDPH. Younger age (p < 0.001) and history of preoperative headache (p ≤ 0.001) were found to increase the risk of PDPH. Use of EBP, either as the primary treatment, or following failed conservative therapy, was found to be a more effective treatment for PDPH than conservative therapies alone (p = 0.017).

CONCLUSIONS: Spinal drain placement carries a risk of PDPH, as supported by an 18.3 % PDPH incidence in this study. Younger patients and/or patients with a history of chronic headache are at elevated risk for PDPH. Treatment using EBP, either as primary therapy or following unsuccessful conservative therapies, is a significantly more effective treatment than conservative therapies alone.