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An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed.
It is done by surgically penetrating the skull, dura mater, and brain such that the ventricular system ventricle of the brain is accessed. When catheter drainage is temporary, it is commonly referred to as an external ventricular drain (EVD). When catheter drainage is permanent, it is usually referred to as a shunt.
It is located on the parietal bone, above the lambdoid suture, 3 to 4 cm lateral to the midline and 6 cm above the inion. [11] It is a common site for ventricular cannulation in the context of inserting a ventriculoperitoneal shunt for the treatment of hydrocephalus. It was first described by C H Frazier in 1928. [12]
The ventricular system is continuous with the central canal of the spinal cord from the fourth ventricle, [3] allowing for the flow of CSF to circulate. [ 3 ] [ 4 ] All of the ventricular system and the central canal of the spinal cord are lined with ependyma , a specialised form of epithelium connected by tight junctions that make up the blood ...
Fourth ventricle location shown in red (E), pons (B); the floor of the ventricle is to the right, the roof to the left. The fourth ventricle has a roof at its upper (posterior) surface and a floor at its lower (anterior) surface, and side walls formed by the cerebellar peduncles (nerve bundles joining the structure on the posterior side of the ventricle to the structures on the anterior side).
It also receives blood from the left marginal vein and the left posterior ventricular vein. [citation needed] Great cardiac vein (run upwards in the anterior interventricular sulcus to the left atrioventricular groove to form the coronary sinus; [6] Middle cardiac vein (ascends posterior interventricular sulcus to drain into coronary sinus); [6]
In more severe cases an external ventricular drain may be required to maintain ICP and evacuate the hemorrhage, and in extreme cases an open craniotomy may be required. [2] [14] In cases of unilateral IVH with small intraparenchymal hemorrhage the combined method of stereotaxy and open craniotomy has produced promising results. [15]
A procedure to place an external ventricular drain may be used to treat hydrocephalus or increased intracranial pressure, however, the use of corticosteroids is frequently avoided. [1] Sometimes surgery to directly remove the blood can be therapeutic. [1] Cerebral bleeding affects about 2.5 per 10,000 people each year. [2]