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External Lumbar Drainage following Traumatic Intracranial Hypertension: A Systematic Review and Meta-Analysis
Jetan Badhiwala1, Angela Lumba-Brown2, Gregory W J Hawryluk3
1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada.
Neurosurgery
|June 25, 2021
Summary
External lumbar drainage (ELD) effectively reduces intracranial pressure (ICP) in traumatic brain injury (TBI) patients. While safe with low complication rates, its long-term efficacy and impact on neurological outcomes require further high-quality research.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Traumatic brain injury (TBI) frequently causes elevated intracranial pressure (ICP) resistant to conventional treatments.
- External lumbar drainage (ELD) is being explored as a potential intervention for refractory intracranial hypertension.
Purpose of the Study:
- To assess the safety and efficacy of ELD in adults with refractory traumatic intracranial hypertension.
- Evaluate immediate and durable effects on ICP, complication rates, and neurological outcomes.
Main Methods:
- Systematic review and meta-analysis of studies identified via PubMed/EMBASE.
- GRADE methodology used for strength of evidence evaluation.
- Random-effects meta-analyses calculated pooled effect sizes.
Main Results:
- Moderate evidence shows ELD significantly lowers ICP immediately (pooled effect size: -19.5 mmHg).
- Low evidence suggests a durable ICP reduction for up to 24 hours.
- Low evidence indicates ELD is safe with low rates of cerebral herniation or meningitis.
Conclusions:
- ELD shows potential safety and feasibility for selected severe TBI patients with refractory intracranial hypertension and specific imaging findings.
- Further high-quality research is needed to determine optimal application conditions and long-term neurological outcomes.
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