{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:52:28Z","timestamp":1789559548484,"version":"build-2803163510"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Guidelines for the management of pediatric severe traumatic brain injury (TBI) recommend external ventricular drainage for CSF drainage as a first-tier treatment in the intracranial pressure (ICP) pathway. However, ventriculostomy in children can sometimes be challenging because of the small size of the lateral ventricles. External lumbar drainage (ELD) may be a useful alternative; therefore, the authors analyzed the outcome of a cohort of pediatric patients who underwent ELD to manage intracranial hypertension (ICH).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study retrospectively enrolled pediatric patients with ICH following severe TBI who underwent ELD. Radiological and clinical severity scores (Marshall classification, Rotterdam score, Injury Severity Score, and Pediatric Trauma Score) were noted. ICP and cerebral perfusion pressure (CPP) curves were analyzed 12 hours before and after the procedure. Any change in medical therapy was recorded, as well as the total volume and duration of drainage. Cerebellar tonsillar position according to the McRae line was noted before and after ELD. Glasgow Outcome Scale-Extended score at follow-up was also noted.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Thirty patients were included, with a mean age of 8 \u00b1 4.4 years, and a median admission Glasgow Coma Scale score of 7 \u00b1 4 (range 3\u201313). ELD was performed after a median delay of 1 day (range 0\u20137 days), mean drainage volume\/day was 296 \u00b1 129 ml, and median duration of drainage was 7 \u00b1 5 (range 2\u201312) days. Forty-three percent of the patients underwent ELD as a part of the first-tier therapy. ICP decreased after ELD (mean difference 13.4 \u00b1 6.2 mm Hg, p &lt; 0.001), whereas CPP increased (mean difference 10.6 \u00b1 6.4 mm Hg, p &lt; 0.001). Fifty-three percent of the cohort did not need any further second-tier therapy after ELD. The study found 1 case of drain revision and 3 cases of cerebellar tonsil herniation.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>These preliminary data suggest ELD is a valuable option to treat ICH in severely head-injured children, limiting the use of second-tier treatments. This pilot study should lay the foundation for a multicenter prospective trial.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.7.peds24156","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T02:29:13Z","timestamp":1726885753000},"page":"566-573","source":"Crossref","is-referenced-by-count":4,"title":["External lumbar drainage for the management of refractory intracranial hypertension in pediatric severe traumatic brain injury: a retrospective single-center case series"],"prefix":"10.3171","volume":"34","author":[{"given":"Lelio","family":"Guida","sequence":"first","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa","family":"Visentin","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Benichi","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syril","family":"James","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Paternoster","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Bourgeois","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Sauv\u00e9-Martin","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Meyer","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesia and Intensive Care, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Montmayeur","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesia and Intensive Care, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Vergnaud","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesia and Intensive Care, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volodia","family":"Dangouloff-Ros","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"},{"name":"Pediatric Radiology, APHP, H\u00f4pital Necker Enfants Malades, Paris;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Beccaria","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Orliaguet","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"},{"name":"Pediatric Anesthesia and Intensive Care, and"},{"name":"EA 7323 \"Pharmacologie et \u00e9valuation des th\u00e9rapeutiques chez l\u2019enfant et la femme enceinte,\" H\u00f4pitaux Universitaires Paris Centre\u2013Site Tarnier, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Blauwblomme","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Neurosurgery,"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3S Suppl 1","key":"b1","series-title":"Pediatr Crit Care Med","first-page":"S1","article-title":"Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines","volume":"20","author":"Kochanek PM","year":"2019","unstructured":"Kochanek PM, Tasker RC, Carney N,  Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines. 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