• Deepti Bhargava, Andrew Alalade, Habib Ellamushi, John Yeh, and Roger Hunter.
• Department of Neurosurgery, Royal London Hospital, London, UK, deeptibhargava7@gmail.com.
• Acta Neurochir (Wien). 2013 Nov 1;155(11):2129-32.

BackgroundCerebrospinal fluid (CSF) drainage has been variably employed to lower intracranial pressure (ICP) in patients with severe head injury. The efficacy of this manoeuvre remains under-explored (Brain Trauma Foundation Recommendation-optional treatment). This work seeks to report the results of CSF drainage via external ventricular drain (EVD) in severe head injury in comparison to other treatment options.MethodsRetrospective observational comparative study of all consecutive patients admitted to a major trauma centre with severe traumatic brain injury over a period of 12 months.ResultsOut of a total 139 patients, 33 had delayed elevation of ICP despite conventional medical therapy, 16 patients were treated with EVD insertion (4 placed under AxiEM image guidance [Medtronic]) and 17 received either decompressive craniectomy or barbiturate coma. Subsequently, two patients with decompression had further ICP elevation and needed EVD. Two patients with EVD had raised ICP-one underwent decompression and the other was treated with barbiturate coma. One patient with EVD developed infection, which was successfully treated. Patients treated with EVD had a lower risk of needing definitive treatment for ICP control, i.e. decompressive craniectomy or barbiturate coma.ConclusionsEVD was a safe and less invasive procedure, and achieved sustained control of ICP in this patient group.

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