Motiei-Langroudi et al evaluated patients with aneurysmal subarachnoid hemorrhage who required permanent diversion of CSF to prevent hydrocephalus. One key finding is the inability to wean the patient from an external ventricular drain inserted to relieve acute hydrocephalus. The authors are from Beth Israel Deaconess Medical Center, University of Alabama, INOVA Health Systems, Seattle Science Foundation and Tabriz University in Iran.

Patient selection: aneurysmal subarachnoid hemorrhage with external ventricular drain inserted


Weaning process: clamping the external drain and evaluating the patient afterward


Criteria for failure to wean the external drain:

(1) sustained intracranial pressure higher than normal (> 20 mm Hg)

(2) ventriculomegaly on brain CT

(3) clinical symptoms associated with hydrocephalus

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