Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 14 1615 1615 Rizya Mahesa Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Department of Anesthesiology and Reanimation, Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia. Fajar Perdhana Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Department of Anesthesiology and Reanimation, Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia. Naomi Rahmasena Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Department of Anesthesiology and Reanimation, Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia. 2026 04 12 2026 05 15 Spinal cord ischemia (SCI) remains a devastating complication of thoracic endovascular aortic repair (TEVAR), particularly in extensive aneurysms such as Crawford type I. Cerebrospinal fluid drainage (CSFD) is widely used to augment spinal cord perfusion pressure (SCPP); however, the optimal timing of CSFD placement (preoperative vs post-induction) remains controversial. A 61-year-old male with Crawford type I (maximum diameter 7 cm), history of cerebral infarction, NSTEMI, and hypoalbuminemia was scheduled for elective TEVAR using the chimney technique. After general anesthesia induction, CSFD was placed at L3-L4 (target CSFP 8-12 mmHg, rate 10-15 mL/h). TEVAR proceeded smoothly with stable hemodynamics (MAP 85-100 mmHg); the drain was removed on postoperative day 2 (48 h) without complications. Neurological status was normal, without PDPH, paraplegia, or infection. This case shows that placing CSFD after induction can be a feasible and safe procedure of a multimodal neuroprotection strategy for high-risk TEVAR. Post-induction CSFD is an alternative to preoperative CSFD placement without compromising spinal cord protection. Further studies are needed to clarify the optimal timing and patient selection for CSFD in TEVAR. https://aacc.tums.ac.ir/index.php/aacc/article/view/1615