Understanding External Ventricular Drains and Their Importance Globally
What is it?
An external ventricular drain (EVD) is a medical device that is used to drain excess cerebrospinal fluid (CSF) from around the brain. It is commonly placed during neurosurgery to relieve elevated intracranial pressure. An EVD consists of a catheter that is inserted through a small hole in the skull and placed into one of the ventricles inside the brain. The other end of the catheter leads to a drainage system outside of the body. This allows for continuous drainage and monitoring of CSF to ensure normal pressure levels are maintained.
EVDs are most often used on a temporary basis for conditions that cause increased intracranial pressure such as traumatic brain injury, hemorrhage, tumors, and hydrocephalus. Once the underlying condition has improved and pressure has stabilized, the drain is typically removed. External Ventricular Drains some patients require long-term drainage with an EVD if their hydrocephalus cannot be treated another way. Proper placement and care of an EVD is crucial for effectively managing increased intracranial pressure and optimizing patient outcomes.
Indications and Benefits of EVD Placement
As mentioned, EVDs are commonly placed to treat elevated intracranial pressure from various neurological conditions and injuries. Some specific indications for EVD placement include:
- Traumatic brain injury - Head injuries that cause bleeding, swelling, and increased pressure inside the skull. Draining excess CSF helps reduce pressure and decrease risk of further injury.
- Intracerebral hemorrhage - Bleeding within the brain tissue such as from a ruptured aneurysm or arteriovenous malformation. Drainage controls swelling to prevent additional damage.
- Subarachnoid hemorrhage - Bleeding occurring between the brain and the tissues covering it, often from an aneurysm. EVDs are used pre- and post-operatively to manage pressure levels.
- Hydrocephalus - A neurological condition where excess CSF builds up in the ventricles, putting pressure on the brain. This is either treated short-term with an EVD until a permanent shunt can be placed or long-term with a ventriculoperitoneal shunt.
- Brain tumors - Both cancerous and non-cancerous growths can cause swelling and increased pressure inside the skull. An EVD provides decompression prior to surgery or radiation/chemotherapy treatments.
The main benefit of EVD placement is that it allows for continuous and precise monitoring and drainage of CSF to maintain normal intracranial pressure levels. This protects the brain from further injury and optimizes recovery from the underlying problem causing increased pressure.
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