title: Keen's Point for External Ventricular Drainage in Traumatic Brain Injury Patients: An Uncommon Indication for An Old Technique.
abstract: BACKGROUND
  In cases of severe traumatic brain injury, cerebrospinal fluid (CSF) diversion though an external ventricular drain (EVD) is a proven method to assist in the control of elevated intracranial pressure. Under normal circumstances, the EVD is placed in a frontal location. However, in cases of multifocal intracranial injury and swelling, collapse of the frontal horns of the lateral ventricles leads to frequent failure of frontal CSF drainage. In this series we describe the utility of the Keen's point EVD as a safe alternative to maintain continuous CSF diversion for patients in whom frontal drainage is not feasible.
  
  
  METHODS
  Three patients (ages 30-46 years) with diffuse intracranial injury following severe trauma were admitted to our neurointensive care unit. One of these patients had decompressive craniectomy before transfer, while the other 2 patients did not undergo any surgical procedures. Each of these patients had severe refractory elevation of intracranial pressure and significant frontal swelling, ultimately necessitating bedside placement of a Keen's point EVD.
  
  
  CONCLUSIONS
  In all cases, we were able to reliably maintain continuous CSF diversion for an extended period of time. There was 1 mortality due to the severity of initial injuries. In the remaining 2 patients, intracranial pressure was able to be normalized following placement of the Keen point EVD. The Keen point EVD is a viable option to maintain continuous CSF drainage in patients with diffuse intracranial injury and should be considered in patients whom a frontal EVD cannot reliably maintain continuous drainage of CSF.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: khuang3@partners.org.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Vamsidhar
authors.initials: V
authors.lastname: Chavakula
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed
keywords: Cerebrospinal fluid diversion; External ventricular drainage; Intracranial hypertension; Keen's point; Traumatic brain injury