Table of Contents

External Ventricular Drainage in Intraventricular Hemorrhage


Definition

External ventricular drainage (EVD) is a core neurosurgical technique in the acute management of intraventricular hemorrhage (IVH), especially when associated with hydrocephalus or elevated intracranial pressure (ICP).

🧠 Purpose

EVD is used to:

🩺 Indications

🛠️ Technical Steps

  1. Position patient supine, head elevated 20–30°
  2. Identify Kocher’s point: 2.5 cm lateral to midline, 1 cm anterior to coronal suture
  3. Drill burr hole, open dura
  4. Advance catheter ~5–6 cm toward foramen of Monro
  5. Confirm bloody CSF return
  6. Connect to drainage system, level at 10–15 cmH₂O above tragus
  7. Monitor ICP and drainage
  8. *Optional*: instill thrombolytics (per protocol)

📊 Evidence Summary

⚠️ Complications

🔄 Alternatives / Adjuncts

🧾 Clinical Pearls


See also:

Guideline

External Ventricular Drainage in Intraventricular Hemorrhage Guideline

Letters to the Editor

In a Letter to the Editor Leite et al. in the *Journal of Neurosurgery* comment on current practices and considerations regarding external ventricular drainage in intraventricular hemorrhage. The authors present their viewpoint on optimal EVD timing, placement technique, cerebrospinal fluid management strategies, and potential complications 1).

Critical Review

* Strengths:

* Weaknesses:

* Verdict:

Score and Takeaway

* Rating: 4 / 10

* Key takeaway for practicing neurosurgeons:

Bottom Line

An anecdotal commentary on EVD use in IVH—thought‑provoking but unsubstantiated. Use as a discussion starter, not as a guideline.

Citation: Leite PI, Rabello PH, Figueiredo EG. Letter to the Editor: A viewpoint on external ventricular drainage in intraventricular hemorrhage. *J Neurosurg.* 2025 Jul 4:1–2. doi:10.3171/2025.3.JNS25426.

Categories: neurosurgery_letters, ivh_management, csf_diversion Tags: intraventricular hemorrhage, external ventricular drainage, EVD technique, opinion piece, commentary

1)
Leite PIF, Rabello PHM, Figueiredo EG. Letter to the Editor. A viewpoint on external ventricular drainage in intraventricular hemorrhage. J Neurosurg. 2025 Jul 4:1-2. doi: 10.3171/2025.3.JNS25426. Epub ahead of print. PMID: 40614284.