A Comprehensive Guide to External Ventricular Drainage Treatment

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

Signs and symptoms indicating the need for External Ventricular Drainage (EVD) include:

Elevated Intracranial Pressure (ICP) includes Symptoms such as severe headache, nausea, vomiting, and altered mental status.
Hydrocephalus Symptoms are gait disturbances, difficulty with balance, urinary incontinence, and cognitive changes.
Patients with severe head injuries or brain hemorrhages may require EVD to manage pressure and fluid buildup.
Intracranial Bleeding such as sudden severe headache, changes in consciousness, or neurological deficits may necessitate EVD placement for monitoring and drainage.

Before performing External Ventricular Drainage (EVD), several diagnostic procedures and tests are typically conducted to assess the patient's condition and determine the necessity of the procedure:

A thorough evaluation of the patient's medical history and current symptoms focuses on signs of elevated intracranial pressure (ICP), neurological deficits, or indications of hydrocephalus.
CT Scan Provides detailed images of the brain to assess for conditions such as hemorrhage, tumors, or ventricular enlargement indicating hydrocephalus.
MRI Offers detailed views of brain structures, useful for identifying obstructive lesions or abnormalities affecting cerebrospinal fluid (CSF) flow.
Intracranial Pressure Monitoring measurement of intracranial pressure to assess the severity of pressure elevation and guide the need for drainage.
Neurological Examination of cognitive function, motor skills, reflexes, and sensory perception to evaluate neurological status and monitor changes.
Examination of cerebrospinal fluid obtained via lumbar puncture or from the EVD itself, assessing for infections, bleeding, or chemical imbalances.

Recovery from EVD placement generally takes three to four days, with most patients discharged from the hospital within seven days. Throughout your hospital stay, medical staff will monitor your heart rate and blood pressure, and antibiotics will be prescribed to prevent infection. Before discharge, your doctor will ensure the proper functioning of the shunt.