Foreword

Cerebral spinal fluid (CSF) diversion via external ventricular drain (EVD) or lumbar drain (LD) placement is frequently the first-line neurosurgical intervention for patients with acute brain injuries. Drain placement allows for emergent relief of brain compression and intracranial hypertension, at times stabilizing a patient for the operating room or even preventing the need for further neurosurgical intervention. These procedures provide the benefits of CSF drainage, intracranial pressure monitoring, and intrathecal medication administration. With proper insertion and management, these drains can remain in place for up to 21 days with minimal infection risk.

The often life-saving procedure of CSF drain placement is the most visible neurosurgical procedure to other medical services when collaboratively managing patients with brain injuries. Many such patients are admitted to the intensive care unit for close monitoring and management. Intensivists and the intensive care team must have expert knowledge of the placement techniques, potential risks, troubleshooting tactics, and ongoing management of CSF drains to prevent infection, provide effective communication with the neurosurgical team, and yield the best possible outcomes for the patients. EVD and LD weaning and clamping trials can lead to neurologic deterioration if the patient is not appropriately monitored. Therefore, a collaborative approach to EVD or LD management is most beneficial.

Drain placement is commonly the first neurosurgical procedure performed by neurosurgery trainees, and they will likely place well over 100 drains throughout a busy neurosurgery residency. These procedures, done at the bedside of an actively deteriorating patient, are often associated with high stress for the clinician. Dr. Rahmani and his notable colleagues adeptly describe the thrill and terror associated with such a procedure in the Introduction.

This book is a superlative handbook that details the intricacies of CSF drainage. Perched at the intersection of neurosurgery and neurocritical care, External Ventricular and Lumbar Drains: Indications, Procedures, and Patient Care guides all clinicians who interact with CSF drainage devices to best practices. We applaud the authors for their dedication to this essential yet often-overlooked topic.