CSFDrainage

CSF drainage, or cerebrospinal fluid drainage, is the removal of cerebrospinal fluid from the central nervous system to relieve elevated intracranial pressure, treat hydrocephalus, or obtain CSF for analysis. It can be performed temporarily with external drainage systems or as part of longer-term diversion strategies.

The most common methods are external ventricular drainage (EVD), in which a catheter is placed into one or more cerebral ventricles to drain CSF externally, and lumbar drainage, in which CSF is drained from the lumbar subarachnoid space. Both require sterile technique and careful monitoring. EVD systems are typically managed by adjusting the height of the drainage column and the rate of drainage to achieve a target ventricular pressure; ongoing assessments may include monitoring opening pressure, CSF output, and imaging as needed. Lumbar drains are used for specific indications such as posthemorrhagic or postoperative CSF leaks, certain forms of meningitis, or temporary CSF diversion.

Indications include intracranial hypertension due to hemorrhage or edema, obstructive hydrocephalus, intraventricular hemorrhage, traumatic brain injury, aneurysm rupture, postoperative care, and, in some cases, intrathecal administration of antibiotics or chemotherapy. CSF sampling or pressure monitoring can also be performed via drain.

Complications include infection (ventriculitis or meningitis), overdrainage with intracranial hypotension or subdural hematomas, catheter obstruction, malposition, and hemorrhage. Care involves sterile maintenance, infection prevention measures, and timely removal when CSF can be managed by other means. External drainage is often a temporary measure or bridge to a permanent shunt if chronic CSF diversion is needed, such as a ventriculoperitoneal shunt.