跟讀練習: External Ventricular Drain (EVD) - 通過影片學習英語口語

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EVD is short for something called an external ventricular drain.

In the brain there are these fluid spaces called the ventricles and the ventricles make this thing called cerebral spinal fluid or CSF.

There are certain circumstances where that fluid that usually is made in the brain and circulates around the brain can be blocked.

Typically this happens when people have hemorrhage in the brain and hemorrhage in the brain can be caused from a variety of reasons but the main one is aneurysm rupture or high blood pressure hemorrhages.

If that fluid builds up and it can't circulate or get out, that pressure builds.

And the pressure can be extremely high to the point where it can actually damage the brain.

We do this procedure called an external ventricular drain to relieve that pressure.

So this procedure is typically done in the emergency room or in the neuro ICU.

Some sedation is given if needed.

We do some local anesthesia right to the area where we're making the incision.

A small, about inch long incision is made just behind the hairline.

And a very small hole is drilled into the skull and a small rubber catheter is placed down into the brain to the fluid space.

Now the fluid can escape through that tube.

We usually drain that to a small bag at the patient's bedside.

Patients are typically in the ICU for many weeks.

The drainage does a couple of things.

One is it decreases the pressure in the brain because that fluid is blocked and sort of bypasses the blockage and gets the fluid out of the brain.

But the other thing is it tends to drain some of the blood that's in the fluid spaces so that blood clears up faster.

Once the blood reabsorbs, the brain circulation can start up.

We do this thing called ventriculostomy or EVD weaning.

And what that means is that we slowly raise the pressure on that drain to see if the patient can absorb their own spinal fluid.

And if they're able to do that, we can simply remove the drain at the bedside and get the drain out of the patient's head.

There are about a 20% of patients that we can't successfully wean the drain.

And the reason for that is there may be too much blood that sort of scarred some of the fluid pathways or it's damaged the absorption mechanism where the fluid gets absorbed.

And in that situation, then the patient needs a surgical procedure called a VP shunt, or a ventriculoperitoneal shunt.

And what that is is a small tube like a ventriculostomy drain that drains down to the belly and permanently drains the spinal fluid for the patient.

We convert that external drain to an internal drain so the patient can go home with it.

Typically after the ventriculostomy drain has been removed, patients do very, very well.

There is a small subset of patients that once they get to a rehab hospital or once they get home, can have something called delayed hydrocephalus, or the way to think of it is delayed fluid buildup.

If they develop signs of increasing headache, if they sort of get more lethargic and they're not waking up as well, and this could be a week or two or even three weeks after,

it's something they wanna call us about so that we can get a CAT scan and look at the fluid spaces to see if there's that delayed fluid buildup.

There is a normal follow-up procedure.

We will get a CAT scan around four weeks.

That's typically when a lot of this delayed fluid buildup is happening.

So if we get a CAT scan at four weeks, sometimes we can detect it before it becomes clinically symptomatic and the patients get lethargic.

We also do a lot of follow up after patients have hemorrhage in the brain.

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跟讀練習: External Ventricular Drain (EVD) - 通過影片學習英語口語

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