External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. Despite this, the optimal drainage and weaning strategies are still unknown. This PRISMA-compliant systematic review and meta-analysis analysed the outcomes of patients undergoing EVD procedures, comparing continuous versus intermittent drainage and rapid versus gradual weaning. Four databases were searched from inception to 01/10/2020. Articles reporting at least 10 patients treated for hydrocephalus secondary to subarachnoid haemorrhage were included. Other inclusion criteria were the description of the EVD drainage and weaning strategies used and a comparison of continuous versus intermittent drainage or rapid versus gradual weaning within the study. Random effect meta-analyses were used to compare functional outcomes, incidence of complications and hospital length of stay. Intermittent external CSF drainage was associated with lower incidence of EVD-related infections (RR = 0.20, 95% CI 0.05–0.72, I-squared = 0%) and EVD blockages compared to continuous CSF drainage (RR = 0.45, 95% CI 0.27–0.74, I-squared = 0%). There was no clear advantage in using gradual EVD weaning strategies compared to rapid EVD weaning; however, patients who underwent rapid EVD weaning had a shorter hospital length of stay (SMD = 0.34, 95% CI 0.22–0.47, I-squared = 0%). Intermittent external CSF drainage after SAH is associated with lower incidence of EVD-related infections and EVD blockages compared to continuous CSF drainage. Patients who underwent rapid EVD weaning had a shorter hospital length of stay and there was no clear clinical advantage in using gradual weaning.

脑室外引流 (EVD) 是最常用的神经外科手术之一。尽管如此，最佳的引流和断奶策略仍然未知。这项符合 PRISMA 的系统评价和荟萃分析分析了接受 EVD 手术的患者的结果，比较了连续引流与间歇引流以及快速与逐渐撤机。从开始到 2020 年 1 月 10 日，搜索了四个数据库。报道了至少 10 名因蛛网膜下腔出血继发脑积水的患者接受治疗的文章。其他纳入标准是对所使用的 EVD 引流和撤机策略的描述，以及研究中连续与间歇引流或快速与逐渐撤机的比较。随机效应荟萃分析用于比较功能结果，并发症的发生率和住院时间。间歇性脑脊液外部引流与较低的 EVD 相关感染发生率相关（RR = 0.20, 95% CI 0.05–0.72,I -squared = 0%）和 EVD 阻塞与连续 CSF 引流相比（RR = 0.45, 95% CI 0.27–0.74, I -squared = 0%）。与快速 EVD 脱机相比，使用逐步 EVD 脱机策略没有明显优势；然而，接受快速 EVD 脱机的患者住院时间较短（SMD = 0.34, 95% CI 0.22–0.47, I -squared = 0%）。与连续 CSF 引流相比，SAH 后间歇性外部 CSF 引流与 EVD 相关感染和 EVD 阻塞的发生率较低有关。接受快速 EVD 脱机的患者住院时间较短，使用逐步脱机没有明显的临床优势。