These prospective randomized studies illustrate the potential efficacy of CSF drainage in preventing paraplegia when the spinal cord is subjected to ischemic insult. In addition to this, CSF drainage has been reported to be effective as a treatment in cases where the ischemic insult has already resulted in paraplegia. Such reports are obviously relevant to traumatic spinal cord injuries in which some ischemic damage would likely already be present by the time CSF drainage was instituted. Ackerman and Traynelis reported on the institution of CSF drainage in 6 patients who suffered ischemic paralysis, 5 of whom were between 12 and 40 hours post-TAAA repair (Ackerman and Traynelis, 2002). In four patients who had their CSF drainage started within 14 hours of the onset of their ischemic symptoms, significant neurologic recovery was achieved. In three of these patients, the neurologic recovery occurred immediately after the CSF catheter was inserted. In two patients who had their CSF drainage started 32 and 27 hours after the onset of symptoms, no neurologic recovery was observed. Safi et al. reported on the initiation of CSF drainage in 8 patients presenting with neurologic deficits 1 to 14 days after TAAA repair (Safi et al., 1997). They observed substantial neurologic recovery of at least 2 Frankel grades in all 8 patients. The interpretation of these results requires acknowledgement of the fact that other treatments such as steroids and vascular support were also instituted, but they do suggest that the principles of modulating spinal cord perfusion pressure with CSF drainage are still applicable in patients who have already suffered ischemic injury to the spinal cord.