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An external ventricular drain (EVD), also referred to as ventriculostomy or extra ventricular drain, is a neurosurgical device used to manage hydrocephalus and reduce elevated intracranial pressure caused by blockages in the normal flow of cerebrospinal fluid (CSF) within the brain.

The temporary drainage of cerebrospinal fluid (CSF) from the lateral ventricles of the brain or the lumbar area of the spine into an external collection bag is known as external drainage and monitoring. Using a mix of gravity and intracerebral pressure, an external ventricular drainage (EVD) system drains CSF. The rate of drainage is determined by the height of the EVD system in relation to the patient's anatomy.

In neurocritical care, EVDs are used to:

Reduce high intracranial pressure (ICP)
CSF (cerebrospinal fluid) that has become infectious should be drained
After surgery or a hemorrhage, drain any crimson CSF or blood
Keep an eye on the CSF flow rate
Patients undergoing open TAA/TAAA repair surgery or who become symptomatic after surgery should have their CSF removed

Types of drainage used in EVD:

Continuous drainage
Intermittent drainage

External ventricular drainage (EVD) decreases increased intracranial pressure (ICP) caused by trauma, disease, haemorrhage, or excess cerebrospinal fluid (CSF). While the underlying brain pathology is being treated, EVD drains CSF, monitors ICP, and stabilises the patient. In subarachnoid haemorrhage, traumatic brain injury, or hydrocephalus, EVD can be life-saving.

You should seek medical attention immediately if you experience any of the following symptoms of increased intracranial pressure: a sudden headache, nausea, vomiting, drowsiness, visual changes, confusion, seizures, or loss of consciousness. These may indicate the need for brain imaging immediately and the possible placement of an EVD.

There is limited planning since EVD is often done in an emergency. Blood test, coagulation studies, and imaging (CT or MRI) are conducted in a planned scenario. The scalp is cleaned and sterilised after consent is obtained. Depending on their well-being, patients can be sedated or under general anaesthesia.

A neurosurgeon places a catheter in the ventricular system of the brain following creation of a minute hole (burr hole) in the cranium, normally in the forehead bone.
To measure and control intracranial pressure and to let CSF be drained out, the catheter is connected to an external draining and monitoring unit.
The drain is pitched to a definite level to control the flow.

The procedure takes 30–60 minutes. The drain is left in place for a few days to weeks based on the underlying condition and response to treatment. Hospitalisation varies with the severity of illness.

Infection
Bleeding
Hematoma
Catheter blockage

EVD can quickly lower brain pressure, halt further brain injury, and allow continued draining and monitoring of the CSF. When needed, it serves as a bridge to more definitive treatments, such as a ventriculoperitoneal (VP) shunt and is essential in treating life-threatening diseases.

In critical care, patients are monitored. Nursing staff continually monitor neurological status and adjust the drainage system. Antibiotics can be given to prevent infection. Once the underlying issue has stabilised, the EVD may be clamped and removed. Neurological exams and repeat imaging monitor continuing care.

The solution's success depends on the underlying illness and how fast the solution is applied. EVD can significantly reduce mortality and improve neurological outcomes in emergency conditions. Sterile procedures and proper management increase overall effectiveness and reduce problems.

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Clinique Averroes

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The multifunctional Averroès Clinic is situated in Marrakech's Guéliz neighborhood. Originally known as Polyclinique Ibn Rochd, Averroès Marrakech now spans three newly refurbished and upgraded floors comprising more than 1500m2, all of which are devoted to the patient's health and well-being.

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Author

Dr. Vijita Jayan

BPT, MPT (Neuro)

18 Years of Experience

With over 18 years of distinguished clinical experience, Dr. Vijita Jayan is a highly accomplished Clinical Director and Rehabilitation Specialist, renowned for her expertise in neuro-rehabilitation, functional recovery, and mobility-dependent case management. Her extensive practical knowledge enables her to design and implement individualized, evidence-based rehabilitation protocols that consistently yield measurable patient outcomes. A prolific researcher and academic writer, she has authored numerous peer-reviewed articles and research papers, significantly advancing the field of rehabilitative medicine. The recipient of multiple prestigious accolades, Dr. Jayan is widely regarded as one of the foremost authorities in Physical Medicine and Rehabilitation, continually shaping neuro-rehabilitative care through research, innovation, and clinical excellence.. View More

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⁠Dr Rakesh Kumar Dua

Spine & Neurosurgeon

25 Years of Experience

Dr. Rakesh Dua has more than 25+ years of clinical experience in spine surgeries. He is currently providing his services as Director, Neuro & Spine Surgery at Fortis Hospital, Shalimar Bagh. Before joining Fortis Hospital, he was associated with Max super-specialist Hospital, Shalimar Bagh as Director Neurosurgery & Head Neuro Spine, and with UCMS & GTB hospital as head of the neurosurgery department. View More

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