Aortic aneurysms are classified according to the extent and position of the aorta involved: thoracic aneurysms (TA), include the ascending or descending aorta within the thoracic cavity, thoracic-abdominal aneurysms (TAA), involving the thoracic and abdominal aorta, and abdominal aortic aneurysms (AAA, involving the abdominal aorta). The outlook for patients with the most extensive aneurysms is very poor if treated medically with a 5 year survival of 20%1. Intervention has been shown to significantly improve survival to greater than 70% over 5 years 2. However, intervention comes with significant risk, with mortality between 3 and 40% and paraplegia between 5-20% dependent on the series1-2. Additional risks are of renal and pulmonary failure requiring prolonged intensive care unit stays. However, paraplegia remains of most concern to doctor and patient. Paraplegia is a consequence of the tenuous nature of the spinal cord blood supply originating from the aorta. Interruption of the blood supply during aortic repair is responsible for neurological dysfunction. Several adjuncts have been developed to reduce this risk including sequential clamping, left-heart bypass, evoked potentials, intercostal reattachment and cerebrospinal fluid (CSF) drainage- all of which are employed at the Liverpool Heart & Chest Hospital. Drainage of spinal fluid and reducing intracranial CSF pressure favours blood perfusion of the spine. In order to perform CSF drainage a spinal drain is inserted in patients preoperatively. This process is tightly regulated through the existing "Spinal Drainage Protocol" produced by the Trust. Issues arise in the following scenarios: