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Cerebrospinal fluid diversion for refractory intracranial hypertension: A United Kingdom and Ireland survey on practice variation
Chowdhury, Yasir A Stevens, Andrew R Soon, Wai Cheong Toman, Emma Chelvarajah, Ramesh Belli, Antonio Davies, David
Chowdhury, Yasir A
Stevens, Andrew R
Soon, Wai Cheong
Toman, Emma
Chelvarajah, Ramesh
Belli, Antonio
Davies, David
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2022-06-12
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Abstract
Introduction Diversion of cerebrospinal fluid (CSF) in a traumatic brain injury (TBI) is an established means for achieving control of intracranial pressure (ICP), aimed at improving intracranial homeostasis. The literature and anecdotal reports suggest a variation in practice between neurosurgical centres internationally, with current guidelines advocating ventricular drainage over lumbar drainage. We sought to establish the current neurosurgical practice in the United Kingdom regarding the methods of ICP control in TBI. Methods A 20-point survey was distributed electronically to British and Irish neurosurgeons after ratification by the Society of British Neurological Surgeons. Questions were directed at the clinician's opinion and experience of lumbar drain usage in patients with TBI: frequency, rationale, and experience of complications. Questions on lumbar drain usage in neurovascular patients were asked for practice comparison. Results Thirty-six responses from 21 neurosurgical centres were returned. Twenty-three per cent (23%) of responders reported using lumbar drains for refractory ICP in TBI patients: six units use lumbar drains and 15 do not. Three units showed partial usage, with mixed "yes/no" responses between consultants. Concerns of tonsillar herniation and familiarity with EVD were commonly given reasons against the usage of lumbar drains. Fifty-six per cent (56%) reported use in neurovascular patients. Conclusion This contemporary practice survey demonstrates mixed practice across the UK and within some centres. Responses and survey feedback demonstrate that the use of lumbar drains in TBI is a polarising topic. The variety of practice between and within neurosurgical units supports consideration of the prospective study of CSF diversion methods for control of refractory ICP in patients with TBI.
Citation
Chowdhury Y A, Stevens A R, Soon W C, et al. (June 12, 2022) Cerebrospinal Fluid Diversion for Refractory Intracranial Hypertension: A United Kingdom and Ireland Survey on Practice Variation. Cureus 14(6): e25877. doi:10.7759/cureus.25877
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35836457 (pubmed)
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Journal article
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en
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© 2022 The Authors. Published by SpringerNature. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: doi.org/10.7759/cureus.25877
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2168-8184
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2168-8184
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All authors have declared that no financial support was received from any organization for the submitted work.
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Licence for published version: Creative Commons Attribution 4.0 International