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External Ventricular Drainage for Hydrocephalus Following Cerebellar Infarction: A Scoping Review.

Tatsuya Tanaka1, Eiichi Suehiro1, Akira Matsuno1

  • 1Department of Neurosurgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 2868520, Japan.

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External ventricular drainage (EVD) is a viable option for cerebellar infarction with obstructive hydrocephalus, especially in selected patients. Suboccipital decompressive craniectomy (SDC) remains crucial for severe cases, suggesting a stepwise approach may optimize outcomes.

Keywords:
cerebellar infarctionexternal ventricular drainageobstructive hydrocephalusscoping reviewsuboccipital decompressionupward herniation

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Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Cerebellar infarction with obstructive hydrocephalus presents a life-threatening challenge.
  • External ventricular drainage (EVD) was historically viewed as hazardous, while suboccipital decompressive craniectomy (SDC) was considered definitive.
  • The optimal management strategy and timing for these interventions remain debated.

Purpose of the Study:

  • To conduct a scoping review on the role and sequencing of EVD and SDC in managing cerebellar infarction with obstructive hydrocephalus.
  • To synthesize current evidence and provide practical clinical context for surgical decision-making.
  • To evaluate the safety and efficacy of EVD as an initial treatment for hydrocephalus in this context.

Main Methods:

  • A systematic scoping review following PRISMA-ScR guidelines.
  • Searched PubMed/MEDLINE from inception to September 2025 for studies on adult patients with cerebellar infarction and obstructive hydrocephalus treated with EVD, with or without SDC.
  • Narrative synthesis of extracted data on study design, patient characteristics, interventions, complications, and outcomes.

Main Results:

  • Forty studies were included, comprising various evidence types.
  • EVD alone is effective in selected conscious patients; SDC or combined approaches improve outcomes in comatose patients.
  • Upward transtentorial herniation signs were common pre-EVD, but clinically significant deterioration was infrequent. Key prognostic factors include infarct volume, location, brainstem involvement, and consciousness level.

Conclusions:

  • EVD is no longer an absolute contraindication for cerebellar infarction with obstructive hydrocephalus.
  • Controlled drainage via EVD can be sufficient for carefully selected patients.
  • A stepwise approach, starting with cautious EVD and escalating to SDC if needed, may optimize patient outcomes.