title: Mitigating effects of external ventricular drain usage in the management of severe head injury.
abstract: BACKGROUND
  Cerebrospinal 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.
  
  
  METHODS
  Retrospective observational comparative study of all consecutive patients admitted to a major trauma centre with severe traumatic brain injury over a period of 12 months.
  
  
  RESULTS
  Out 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.
  
  
  CONCLUSIONS
  EVD was a safe and less invasive procedure, and achieved sustained control of ICP in this patient group.
authors.affiliation: Department of Neurosurgery, Royal London Hospital, London, UK, deeptibhargava7@gmail.com.
authors.forename: Deepti
authors.initials: D
authors.lastname: Bhargava
authors.forename: Andrew
authors.initials: A
authors.lastname: Alalade
authors.forename: Habib
authors.initials: H
authors.lastname: Ellamushi
authors.forename: John
authors.initials: J
authors.lastname: Yeh
authors.forename: Roger
authors.initials: R
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D000328:Adult; D006259:Craniocerebral Trauma / Q000134:cerebrospinal fluid* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult