Bedside external ventricular drain placement for haemorrhagic stroke patients with brain herniation and acute hydrocephalus: A case series

Aim External ventricular drainage (EVD) for patients with acute hydrocephalus is a potentially life‐saving neurosurgical procedure that can be quickly performed at the bedside, but is rarely carried out in Hong Kong. Patients and Methods The present study is a retrospective review of eight adult patients who underwent bedside EVD from 1 January 2010 to 31 March 2018 at Hong Kong's public neurosurgical centres. Disease aetiology, neurological presentation, radiological findings, procedure‐related complications and functional outcomes were reviewed. Results The mean age was 56 years, with a median presenting Glasgow Coma Score of 3/15 with half having at least one fixed dilated pupil. All were treated at a single neurosurgical centre. Five patients had haemorrhagic stroke (63 per cent) with aneurysmal subarachnoid haemorrhage. After bedside EVD, five patients were stable enough to attempt further definitive surgery. All catheters were placed accurately achieving Kakarla grade I, and there were no procedure‐related complications. Three patients survived (38 per cent), with one having a mild disability (modified Rankin score of 2) at 1 year after stroke. Conclusion Our experience indicates that bedside EVD is a feasible life‐saving procedure that can be performed in selected rapidly deteriorating haemorrhagic stroke patients with brain herniation in our locality.