Department of Neurosurgery, Royal London Hospital, London, UK,
Acta Neurochir (Wien). 2013 Nov;155(11):2129-32. doi: 10.1007/s00701-013-1735-8. Epub 2013 Jun 1.
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.
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.
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.
EVD was a safe and less invasive procedure, and achieved sustained control of ICP in this patient group.
脑脊液（CSF）引流术已被不同程度地应用于降低严重颅脑损伤患者的颅内压（ICP）。该操作的疗效仍有待探索（颅脑创伤基金会推荐-可选治疗）。本研究旨在报告通过外部脑室引流（EVD）治疗严重颅脑损伤的结果，并与其他治疗方法进行比较。
对 12 个月内连续入住大型创伤中心的所有严重创伤性脑损伤患者进行回顾性观察性比较研究。
在总共 139 名患者中，33 名患者尽管接受了常规药物治疗，但 ICP 仍延迟升高，16 名患者接受了 EVD 插入（4 名在 AxiEM 图像引导下进行[美敦力]），17 名患者接受了去骨瓣减压术或巴比妥昏迷治疗。随后，两名接受减压的患者 ICP 再次升高，需要 EVD。两名接受 EVD 的患者 ICP 升高，一名接受了减压，另一名接受了巴比妥昏迷治疗。一名接受 EVD 的患者发生感染，经治疗后成功治愈。接受 EVD 治疗的患者需要进行明确的 ICP 控制治疗（即去骨瓣减压术或巴比妥昏迷）的风险较低。
EVD 是一种安全且创伤较小的操作，在该患者组中实现了 ICP 的持续控制。
