Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Faculty of Medicine, El Bosque University, Semillero Investigación Neurotrauma, Group of Investigation INUB-MEDITECH, Institute of Neuroscience and Neurosurgery, El Bosque University, Bogotá, Colombia.
Neurochirurgie. 2022 Feb;68(2):206-211. doi: 10.1016/j.neuchi.2021.05.004. Epub 2021 May 26.
The Brain Trauma Foundation (BTF) published evidence-based guidelines with a detailed approach to the management of intracranial hypertension (ICH) in traumatic brain injury (TBI) patients. However, management with cerebrospinal fluid (CSF) drainage in TBI patients remains a controversial topic and is a recent addition to the 4 Edition of the BTF guidelines. External lumbar drainage (ELD) has been proposed for the management of patients with refractory ICH despite aggressive measures. ELD has been described in the literature with possible benefits in outcomes; still, many questions remain unanswered.
A systematic search on MEDLINE was conducted for articles that studied lumbar CSF drainage in adult TBI patients with ICH.
Eleven studies met the inclusion criteria, which included 5 prospective and 6 retrospective studies. Several studies showed that CSF drainage via lumbar drain resulted in significant reduction of ICP compared to before ELD placement and had a low complication rate. However, the data reporting mortality and functional outcomes are varied across studies.
The literature suggests that ELD may play a role in the management of refractory ICH in TBI patients when first and second-tier measures fail and may be a safe, effective, and minimally invasive method to significantly lower ICP. Additional research and standardized treatment protocols are necessary.
颅脑创伤基金会（BTF）发布了循证指南，详细介绍了创伤性脑损伤（TBI）患者颅内高压（ICH）的管理方法。然而，TBI 患者行脑脊液（CSF）引流的管理仍然是一个有争议的话题，也是 BTF 指南第 4 版的新增内容。对于尽管采取了积极措施但仍存在难治性 ICH 的患者，已提出采用外部腰椎引流（ELD）进行治疗。ELD 在文献中有被描述，其结果可能具有一定益处，但仍有许多问题尚未得到解答。
在 MEDLINE 上进行了系统检索，以查找研究成人 TBI 合并 ICH 患者腰椎 CSF 引流的文章。
符合纳入标准的研究有 11 项，包括 5 项前瞻性研究和 6 项回顾性研究。多项研究表明，与 ELD 放置前相比，腰椎引流可显著降低 ICP，且并发症发生率较低。然而，各研究报告的死亡率和功能结局数据存在差异。
文献表明，当一线和二线措施失败时，ELD 可能在 TBI 患者难治性 ICH 的治疗中发挥作用，并且可能是一种安全、有效且微创的方法，可显著降低 ICP。需要进一步研究和制定标准化的治疗方案。
