External ventricular drainage indications

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External ventricular drainage (EVD) is a life-saving procedure indicated for elevated intracranial pressure.

Acute symptomatic hydrocephalus:

Signs of raised intracranial pressure (ICP): headache, nausea, vomiting, altered mental status.

Neurological deterioration related to ventriculomegaly on imaging.

Intracranial hypertension with ventricular enlargement.

Obstructive hydrocephalus caused by blood clots within the ventricular system.

They are also used to drain CSF and to monitor the flow of CSF from the ventricular system in order (1) to control intracranial pressure (ICP), (2) to evaluate CSF chemistry and cytology, and (3) to provide temporary egress for CSF in patients with infected or malfunctioning cerebrospinal fluid shunts.

The optimal setting for EVD placement in regards to safety and accuracy of placement is poorly defined.

After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe the ventricular size and clinical status. This practice may lead to a prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation.

External ventricular drain for hydrocephalus

External ventricular drain for chronic subdural hematoma

External ventricular drain for severe traumatic brain injury.

External ventricular drain for community-acquired meningitis.

Place a fresh external ventricular drain (if shunt-dependent hydrocephalus).

For Traumatic cerebellar hemorrhage patients, perioperative EVD is safe and can significantly improve neurological prognosis. Especially for patients whose GCS dropped by more than 2 points before the operation, EVD can significantly improve the patient's GCS score, reduce the risk of herniation, and gain more time for surgical preparation. Even for TICH patients without acute hydrocephalus on admission CT scan, EVD placement still has positive clinical significance. ¹⁾