Background

The Brain Trauma Foundation (BTF) published evidence-based guidelines with a detailed approach to the management of intracranial hypertension (ICH) in traumatic brain injury (TBI) patients. However, management with cerebrospinal fluid (CSF) drainage in TBI patients remains a controversial topic and is a recent addition to the 4^th Edition of the BTF guidelines. External lumbar drainage (ELD) has been proposed for the management of patients with refractory ICH despite aggressive measures. ELD has been described in the literature with possible benefits in outcomes; still, many questions remain unanswered.

Methods

A systematic search on MEDLINE was conducted for articles that studied lumbar CSF drainage in adult TBI patients with ICH.

Results

Eleven studies met the inclusion criteria, which included 5 prospective and 6 retrospective studies. Several studies showed that CSF drainage via lumbar drain resulted in significant reduction of ICP compared to before ELD placement and had a low complication rate. However, the data reporting mortality and functional outcomes are varied across studies.

Conclusion

The literature suggests that ELD may play a role in the management of refractory ICH in TBI patients when first and second-tier measures fail and may be a safe, effective, and minimally invasive method to significantly lower ICP. Additional research and standardized treatment protocols are necessary.

中文翻译：

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腰椎外引流术治疗颅脑外伤颅内高压的研究进展

背景

脑创伤基金会 (BTF) 发布了循证指南，其中详细介绍了创伤性脑损伤 (TBI) 患者颅内高压 (ICH) 的管理方法。然而，TBI 患者的脑脊液 (CSF) 引流管理仍然是一个有争议的话题，并且是 BTF 指南第 4 版的最新^补充。尽管采取了积极措施，但已提出腰椎外引流术 (ELD) 用于治疗难治性 ICH 患者。文献中描述了 ELD 可能对结果有益；尽管如此，仍有许多问题没有得到解答。

方法

对 MEDLINE 进行了系统搜索，以寻找研究成人 TBI 合并 ICH 患者腰椎 CSF 引流的文章。

结果

11 项研究符合纳入标准，其中包括 5 项前瞻性研究和 6 项回顾性研究。几项研究表明，与 ELD 放置前相比，通过腰椎引流管引流脑脊液导致 ICP 显着降低，并且并发症发生率较低。然而，报告死亡率和功能结果的数据因研究而异。

结论

文献表明，当一级和二级措施失败时，ELD 可能在 TBI 患者难治性 ICH 的管理中发挥作用，并且可能是显着降低 ICP 的安全、有效和微创方法。额外的研究和标准化的治疗方案是必要的。