This video is intended to serve as an introduction to external ventricular drainage, and the indications and strategies for intracranial pressure monitoring and interpretation of intracranial pressure waveforms. We will also touch on relationship between intracranial pressure and autoregulation, and discuss the complication of external ventricular drainage and an approach to weaning. The topic is for geared towards advanced medical students (sub-interns) and junior residents.

00:05 - Introduction
01:02 - OBJECTIVES
02:00 - CASE
06:03 - INDICATIONS FOR ICP MONITORING
07:31 - Glasgow Coma Scale
10:30 - MONITOR TYPES
11:16 - Intraventricular monitor (EVD)
13:12 - Intraparenchymal monitors
15:11 - Epidural monitors
16:21 - Subarachnoid monitors
18:34 - EXTERNAL VENTRICULAR DRAINAGE
25:58 - Adjusting the EVD
32:53 - PRESSURE MONITORING
34:41 - Low-compliance waveform
35:30 - Intracranial volume versus intracranial pressure
37:00 - Autoregulation curve and cerebral perfusion pressure
44:27 - Approach to ICP crisis
49:12 - EVD COMPLICATIONS: INTRACRANIAL INFECTIONS
54:18 - WEANING


CREATED AND NARRATED BY:
Maria Victoria Castillo, MD
4th-year medical student, recent graduate
Rutgers Rutgers Robert Wood Johnson Medical School

Igor Rybinnik MD
Neurology Clerkship Director

Roger Cheng MD
Division of Stroke and Neurocritical Care
Department of Neurology
Rutgers Robert Wood Johnson Medical School

CONTENT EXPERT:
Roger Cheng MD
Division of Stroke and Neurocritical Care
Department of Neurology
Rutgers Robert Wood Johnson Medical School

Images, videos adapted from:
- Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. Saunders, 2013.
- Illustration of EVD placement by Elyssa Siegel
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
- Sonig A, et al. World Neurosurg, 2020;138:491-7
- Graffeo CS, Cole TS, Lawton MT, Barrow Neurological Institute, 2021


References:
- Bratton SL J of Neurotrauma, 2007; 24(Suppl. 1):S37–S44.
- Fried HI, et al. Neurocrit Care 2016;24(1):61-81
- Veldeman M, et al. Stroke 2021;52:3624–32
- Moore L, et al. J Trauma 2006;60(6):1238-43
- Reith FC, et al. Intensive Care Med 2016;42(1):3-15
- Palasz J, et al. Neurosurg Rev. 2022;45(1):365-73
- Zacchetti L, et al. Crit Care 2015;19:420
- Volovici V, et al. Acta Neurochirurgica 2022;164:1693–1705
- Greitz D. Neurosurg Rev (2004) 27: 145–165
- Mokri B. Neurology 2001;56:1746-8
- Monro A. Observations on structure and functions of the nervous system. Edinburgh: Creech and Johnson, 1783.
- Cucciolini G, et al. J Anesth Analg Crit Care 2023;3:31
- Rose JC, Mayer SA. Neurocrit Care 2004;1:287-99
- Lidington D, et al. Front Neurol 2021;12:1-29
- Dorresteijn KRIS, et al. Neurology 2019;93(22):964-972
- Walti LN, et al. J Infect 2013 May;66(5):424-31
- Rogers T, et al. Open Forum Infect Dis 2019;6(3):ofz050
- Srihawan C, et al. Open Forum Infect Dis 2016;3(2):ofw077
- Ebel F, et al. Neurocrit Care 2023;39(1):250-259



Music, Sounds:
- "Parzival" by William Rosati
- "Warriyo" by Mortals

DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.