Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008;63(1 Suppl 1):ONS162–6; discussion ONS6–7. https://doi.org/10.1227/01.neu.0000335031.23521.d0.

O'Neill BR, Velez DA, Braxton EE, Whiting D, Oh MY. A survey of ventriculostomy and intracranial pressure monitor placement practices. Surg Neurol. 2008;70(3):268–73; discussion 73. https://doi.org/10.1016/j.surneu.2007.05.007.

Srinivasan VM, O’Neill BR, Jho D, Whiting DM, Oh MY. The history of external ventricular drainage. J Neurosurg. 2014;120(1):228–36. https://doi.org/10.3171/2013.6.JNS121577.

Article  PubMed  Google Scholar 

•• Thamjamrassri T, Yuwapattanawong K, Chanthima P, Vavilala MS, Lele AV, Collaborators EVS. A narrative review of the published literature, hospital practices, and policies related to external ventricular drains in the United States: the External Ventricular Drain Publications, Practices, and Policies (EVDPoP) study. J Neurosurg Anesthesiol. 2022;34(1):21–8. https://doi.org/10.1097/ANA.0000000000000694. This narrative review is based on surveys conducted to evaluate EVD management practices in the USA with the main focus on practices to reduce EVD-associated infections. It found modest adherence to guidelines recommendations.

Article  PubMed  Google Scholar 

Baum GR, Hooten KG, Lockney DT, Fargen KM, Turan N, Pradilla G, et al. External ventricular drain practice variations: results from a nationwide survey. J Neurosurg. 2017;127(5):1190–7. https://doi.org/10.3171/2016.9.JNS16367.

Article  PubMed  Google Scholar 

Gigante P, Hwang BY, Appelboom G, Kellner CP, Kellner MA, Connolly ES. External ventricular drainage following aneurysmal subarachnoid haemorrhage. Br J Neurosurg. 2010;24(6):625–32. https://doi.org/10.3109/02688697.2010.505989.

Article  PubMed  Google Scholar 

Ellington E, Margolis G. Block of arachnoid villus by subarachnoid hemorrhage. J Neurosurg. 1969;30(6):651–7. https://doi.org/10.3171/jns.1969.30.6.0651.

CAS  Article  PubMed  Google Scholar 

Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21(2):263–70. https://doi.org/10.1016/j.nec.2009.10.013.

Article  PubMed  Google Scholar 

Ransom ER, Mocco J, Komotar RJ, Sahni D, Chang J, Hahn DK, et al. External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: effect on preoperative grading and prognosis. Neurocrit Care. 2007;6(3):174–80. https://doi.org/10.1007/s12028-007-0019-7.

Article  PubMed  Google Scholar 

van Lieshout JH, Pumplun I, Fischer I, Kamp MA, Cornelius JF, Steiger HJ, et al. Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal rebleeding. J Neurosurg. 2018;128(6):1778–84. https://doi.org/10.3171/2017.2.JNS162748.

Article  PubMed  Google Scholar 

McIver JI, Friedman JA, Wijdicks EF, Piepgras DG, Pichelmann MA, Toussaint LG 3rd, et al. Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2002;97(5):1042–4. https://doi.org/10.3171/jns.2002.97.5.1042.

Article  PubMed  Google Scholar 

Hellingman CA, van den Bergh WM, Beijer IS, van Dijk GW, Algra A, van Gijn J, et al. Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(1):96–9. https://doi.org/10.1161/01.STR.0000251841.51332.1d.

Article  PubMed  Google Scholar 

Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15. https://doi.org/10.1227/NEU.0000000000001432.

Liu H, Wang W, Cheng F, Yuan Q, Yang J, Hu J, et al. External ventricular drains versus intraparenchymal intracranial pressure monitors in traumatic brain injury: a prospective observational study. World Neurosurg. 2015;83(5):794–800. https://doi.org/10.1016/j.wneu.2014.12.040.

Article  PubMed  Google Scholar 

Atzema C, Mower WR, Hoffman JR, Holmes JF, Killian AJ, Wolfson AB, et al. Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma. J Trauma. 2006;60(5):1010–7; discussion 7. https://doi.org/10.1097/01.ta.0000218038.28064.9d.

Nieuwkamp DJ, Rinkel GJ, Silva R, Greebe P, Schokking DA, Ferro JM. Subarachnoid haemorrhage in patients > or = 75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry. 2006;77(8):933–7. https://doi.org/10.1136/jnnp.2005.084350.

CAS  Article  PubMed  PubMed Central  Google Scholar 

Roos YB, Hasan D, Vermeulen M. Outcome in patients with large intraventricular haemorrhages: a volumetric study. J Neurol Neurosurg Psychiatry. 1995;58(5):622–4. https://doi.org/10.1136/jnnp.58.5.622.

CAS  Article  PubMed  PubMed Central  Google Scholar 

Mayfrank L, Kissler J, Raoofi R, Delsing P, Weis J, Kuker W, et al. Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke. 1997;28(1):141–8. https://doi.org/10.1161/01.str.28.1.141.

Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006;5(1):53–63. https://doi.org/10.1016/S1474-4422(05)70283-0.

Article  PubMed  Google Scholar 

Hanley DF, Lane K, McBee N, Ziai W, Tuhrim S, Lees KR, et al. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet. 2017;389(10069):603–11. https://doi.org/10.1016/S0140-6736(16)32410-2.

CAS  Article  PubMed  PubMed Central  Google Scholar 

•• van Solinge TS, Muskens IS, Kavouridis VK, Gormley WB, Mekary RA, Broekman MLD, et al. Fibrinolytics and intraventricular hemorrhage: a systematic review and meta-analysis. Neurocrit Care. 2020;32(1):262–71. https://doi.org/10.1007/s12028-019-00786-5. This systematic review of intraventricular fibrinolytic use for intraventricular hemorrhage reviews many studies with over 1000 patients finding lower mortality and lower EVD obstruction with shorter time to clearance with use of intrathecal fibrinolytic, however no difference in good functional outcome.

Schwab S, Aschoff A, Spranger M, Albert F, Hacke W. The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology. 1996;47(2):393–8. https://doi.org/10.1212/wnl.47.2.393.

CAS  Article  PubMed  Google Scholar 

Poca MA, Benejam B, Sahuquillo J, Riveiro M, Frascheri L, Merino MA, et al. Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful? J Neurosurg. 2010;112(3):648–57. https://doi.org/10.3171/2009.7.JNS081677.

Article  PubMed  Google Scholar 

Braksick SA, Himes BT, Snyder K, Van Gompel JJ, Fugate JE, Rabinstein AA. Ventriculostomy and risk of upward herniation in patients with obstructive hydrocephalus from posterior fossa mass lesions. Neurocrit Care. 2018;28(3):338–43. https://doi.org/10.1007/s12028-017-0487-3.

Article  PubMed  Google Scholar 

Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50(12):3331–2. https://doi.org/10.1161/STROKEAHA.119.027708.

Article  PubMed  Google Scholar 

Abulhasan YB, Rachel SP, Chatillon-Angle MO, Alabdulraheem N, Schiller I, Dendukuri N, et al. Healthcare-associated infections in the neurological intensive care unit: results of a 6-year surveillance study at a major tertiary care center. Am J Infect Control. 2018;46(6):656–62. https://doi.org/10.1016/j.ajic.2017.12.001.

Article  PubMed  Google Scholar 

Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 infectious diseases society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34–65. https://doi.org/10.1093/cid/ciw861.

CAS  Article  PubMed  PubMed Central  Google Scholar 

•• Chang H, Silva MA, Giner A, Ancheta S, Romano JG, Komotar R, et al. Effects of an external ventricular drain alert protocol on venticulostomy placement time in the emergency department. Neurosurg Focus. 2021;51(5):E4. https://doi.org/10.3171/2021.8.FOCUS21378. This study evaluates factors that result in delays in EVD placement in the ED. It then describes implementation of an automated EVD alert system that showed significant reduction in EVD placement time.

Article  PubMed  Google Scholar 

•• Dawod G, Henkel N, Karim N, Caras A, Qaqish H, Mugge L, et al. Does the setting of external ventricular drain placement affect morbidity? A systematic literature review comparing intensive care unit versus operating room procedures. World Neurosurg. 2020;140:131–41. https://doi.org/10.1016/j.wneu.2020.04.215. A systematic review of the literature studying the difference in placing EVDs in the ICU vs operating rooms with overall inconclusive results while comparing efficacy and morbidity between both locations.

Ehtisham A, Taylor S, Bayless L, Klein MW, Janzen JM. Placement of external ventricular drains and intracranial pressure monitors by neurointensivists. Neurocrit Care. 2009;10(2):241–7. https://doi.org/10.1007/s12028-008-9097-4.

Article  PubMed  Google Scholar 

•• Eisenring CV, Burn F, Baumann M, Stieglitz LH, Kockro RA, Beck J, et al. sEVD-smartphone-navigated placement of external ventricular drains. Acta Neurochir (Wien). 2020;162(3):513–21. https://doi.org/10.1007/s00701-019-04131-9. The purpose of this study is to provide data on possible increase in EVD placement safety by using a novel guide for EVD positioning using multimodal simulation on cadavers and 3D advanced technologies showing safer and effective EVD placement. Requiers further validation in clinical studies.

Umana GE, Scalia G, Yagmurlu K, Mineo R, Di Bella S, Giunta M, et al. Multimodal simulation of a novel device for a safe and effective external ventricular drain placement. Front Neurosci. 2021;15: 690705. https://doi.org/10.3389/fnins.2021.690705.

Article  PubMed  PubMed Central  Google Scholar 

•• Ellens NR, Fischer DL, Meldau JE, Schroeder BA, Patra SE. External ventricular drain placement accuracy and safety when done by midlevel practitioners. Neurosurgery. 2019;84(1):235–41. https://doi.org/10.1093/neuros/nyy090. This is a retrospective study of EVD placement accuracy and complications in a level 1 trauma center by midlevel practioners compared to neurosurgeons. It showed no significant difference in accuracy of placement or complication rate which may allow earlier management of high ICP when prompt access to neurosurgeons is limited.

Poon WS, Ng S, Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study. Acta Neurochir Suppl. 1998;71:146–8. https://doi.org/10.1007/978-3-7091-6475-4_43.

CAS  Article  PubMed  Google Scholar 

Murphy RK, Liu B, Srinath A, Reynolds MR, Liu J, Craighead MC, et al. No additional protection against ventriculitis with prolonged systemic antibiotic prophylaxis for patients treated with antibiotic-coated external ventricular drains. J Neurosurg. 2015;122(5):1120–6. https://doi.org/10.3171/2014.9.JNS132882.

Article  PubMed  PubMed Central  Google Scholar 

•• Lord AS, Nicholson J, Lewis A. Infection prevention in the neurointensive care unit: a systematic review. Neurocrit Care. 2019;31(1):196–210. https://doi.org/10.1007/s12028-018-0568-y. This systematic review looked into studies in patients admitted to neurointensive care units with interventions designed to prevent ICU-acquired infections. It highlighted the need for further collaborative multi-disciplinary approaches to reduce infections including VRI, SSI, VAP, CAUTI, and CLABSI.

Fried HI, Nathan BR, Rowe AS, Zabramski JM, Andaluz N, Bhimraj A, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement : a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24(1):61–81. https://doi.org/10.1007/s12028-015-0224-8.

Article  PubMed  Google Scholar 

•• Garg K, Verma SK, Singh PK, Singh M, Chandra PS, Kale SS. Effect of external ventricular drain tunnel length on cerebrospinal fluid infection rates-a Bayesian network meta-analysis. World Neurosurg. 2021. https://doi.org/10.1016/j.wneu.2021.11.009. A meta-analysis that looked into rates of EVD-associated CSF infection with various EVD tunneling lengths showing that a tunnel length of 5–10 cm was associated with lowest risk of infections.

Article  PubMed  PubMed Central  Google Scholar 

Cui Z, Wang B, Zhong Z, Sun Y, Sun Q, Yang G, et al. Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: a systematic review and meta-analysis. Am J Infect Control. 2015;43(7):e23-32. https://doi.org/10.1016/j.ajic.2015.03.015.

Article  PubMed  Google Scholar 

Harrop JS, Sharan AD, Ratliff J, Prasad S, Jabbour P, Evans JJ, et al. Impact of a standardized protocol and antibiotic-impregnated catheters on ventriculostomy infection rates in cerebrovascular patients. Neurosurgery. 2010;67(1):187–91; discussion 91. https://doi.org/10.1227/01.NEU.0000370247.11479.B6.

Sonabend AM, Korenfeld Y, Crisman C, Badjatia N, Mayer SA, Connolly ES Jr. Prevention of ventriculostomy-related infections with prophylactic antibiotics and antibiotic-coated external ventricular drains: a systematic review. Neurosurgery. 2011;68(4):996–1005. https://doi.org/10.1227/NEU.0b013e3182096d84.

Article  PubMed  Google Scholar 

Zabramski JM, Whiting D, Darouiche RO, Horner TG, Olson J, Robertson C, et al. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg. 2003;98(4):725–30. https://doi.org/10.3171/jns.2003.98.4.0725.

Article  PubMed  Google Scholar 

Pople I, Poon W, Assaker R, Mathieu D, Iantosca M, Wang E, et al. Comparison of infection rate with the use of antibiotic-impregnated vs stan