| Purpose of the guideline: |
External cerebrospinal fluid (CSF) drainage is a commonly used therapeutic technique in neurosurgery, includes external ventricular drainage (EVD) and lumbar cistern drainage (LD). It primarily involves the continuous drainage of CSF from the ventricles or lumbar cistern through a closed system to the outside of the body, aiming to release bloody or infected CSF. Additionally, it can be utilized for monitoring and controlling intracranial pressure, as well as for drug injection through the drainage tube. External CSF drainage is suitable for conditions such as cerebral hemorrhage accompanied by acute hydrocephalus, subarachnoid hemorrhage, intracranial hypertension, and intracranial infection. However, both drainage methods have contraindications. For instance, EVD is relatively contraindicated in patients with coagulation disorders and puncture site infections, while LD is contraindicated in patients with acute brain herniation, severe increase in intracranial pressure, lumbar deformity or bone destruction, severe systemic infection, high cervical spinal cord space-occupying lesions, and incomplete obstruction of the CSF circulation pathway. When implementing these drainage techniques, it is crucial to comprehensively evaluate the indications and contraindications based on the patient's specific condition and disease progression, to ensure the safety and effectiveness of treatment.
Perioperative management of cerebrospinal fluid external drainage is crucial for successful treatment, encompassing the selection of drainage tubes, adjustment of drainage volume, removal of drainage tubes, and management of complications. Although the technique of cerebrospinal fluid external drainage has a low technical threshold and can be performed by hospitals at all levels, there is no consensus on issues related to drainage tube management. Therefore, the Neurosurgery Branch of the Chinese Medical Association and the Chinese Neurosurgery Critical Care Management Collaboration Group organized experts in the field of neurosurgery critical care to rewrite the 2018 "Expert Consensus on Cerebrospinal Fluid External Drainage Management in Neurosurgery Critical Patients" based on evidence-based medicine evidence combined with expert opinions, and formulated the "Expert Consensus on Cerebrospinal Fluid External Drainage Management in Neurosurgery Critical Patients (2024)". |
