title: CSF Lumbar Drainage: A Safe Surgical Option in Refractory Intracranial Hypertension Associated with Acute Posttraumatic External Hydrocephalus.
abstract: External lumbar drainage (ELD) of cerebrospinal fluid (CSF) in posttraumatic refractory intracranial hypertension (ICHT) is controversial. We report our experience of ELD in ICHT associated with acute disturbance of CSF flow within subarachnoid spaces (SASs).
  
  
  
  Four adult patients admitted to the neurointensive care unit for severe TBI who presented with secondary ICHT are retrospectively reported. When refractory to second-tier therapy, if external ventricular drainage were not possible or failed, and in the absence of an indication for craniotomy to treat a mass lesion or decompressive craniectomy, we assessed the evolution of CSF volume within cranial SAS and checked the presence of basal cisterns and the absence of tonsillar herniation to evaluate interest in and the safety of ELD.
  
  
  
  As second-tier therapy failed to lower intracranial pressure (ICP; mean ICP 37 ± 5 mmHg), and computed tomography (CT) showed abnormally enlarged cranial SAS following traumatic subarachnoid hemorrhage, patients received ELD. ICP decreased, with immediate and long-term effect (mean ICP 5 mmHg ± 2 mmHg). There were no complications to report.
  
  
  
  Acute traumatic external hydrocephalus may explain some of the specific situations of secondary increased ICP, with a "normal" CT scan, that is refractory to medical treatment. In these situations, lumbar drainage should be considered to be a safe, minimally invasive, and effective surgical option.
authors.affiliation: Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Étienne, France. romain.manet@neurochirurgie.fr.|Service de neurochirurgie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint-Priest-en-Jarez, 42 270, France. romain.manet@neurochirurgie.fr.
authors.forename: R
authors.initials: R
authors.lastname: Manet
authors.affiliation: Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France.
authors.forename: E A
authors.initials: EA
authors.lastname: Schmidt
authors.affiliation: Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Étienne, France.
authors.forename: F
authors.initials: F
authors.lastname: Vassal
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Saint Etienne, Saint-Étienne, France.
authors.forename: D
authors.initials: D
authors.lastname: Charier
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Saint Etienne, Saint-Étienne, France.
authors.forename: L
authors.initials: L
authors.lastname: Gergelé
mesh_terms: D001463:Barbiturates / Q000627:therapeutic use; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology*; D007036:Hypothermia, Induced; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000379:methods*; D020206:Subarachnoid Hemorrhage, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging; D013346:Subarachnoid Space / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D001463:Barbiturates
keywords: External hydrocephalus; External lumbar drainage; Head trauma; Intracranial hypertension; Intracranial pressure; Posttraumatic hydrocephalus; Second-tier therapy; Traumatic brain injury; Traumatic subarachnoid hemorrhage