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[Background] Hydrocephalus, derived from the Greek words hydro (water) and kephalos
(head), describes a congenital or acquired condition in which there is an excessive accumulation
of cerebrospinal fluid (CSF) within the head. There is a wide range of causes, most of which
involve obstructed CSF circulation or impaired absorption.
[Object] The aim of this study was to distinguish between the clinical features of
communicating and non-communicating hydrocephalus; define the indications for external
ventricular drains (EVD), ventriculo-peritoneal shunts and lumbar drains and explain the
practical aspects of EVD management in intensive care.
[Materials and Method] The authors performed a systematic literature review and meta-
analysis to estimate the incidence of congenital hydrocephalus by WHO region and World Bank
income level using the MEDLINE/PubMed and Cochrane Database of Systematic Reviews
[Results] Seventy-eight articles were included from the systematic review, representative of
all WHO regions and each income level. The pooled incidence of hydrocephalus was highest in
Africa and Latin America (145 and 316 per 100,000, respectively) and lowest in the United
States/Canada (68 per 100,000) (p for interaction < 0.1). The incidence was higher in low- and
middle-income countries (123 per 100,000; 95% CI 98–152) than in high-income countries (79
per 100,000; 95% CI 68–90) (p for interaction < 0.01).
[Discussion and Conclusion] Short-term or long-term CSF diversion procedures are the
neurosurgical operations performed most frequently. When an EVD is used, the transducer must
be zeroed at the level of external auditory meatus with the patient supine. If the patient’s position
is changed, the drainage system should be clamped briefly and re-levelled and re-zeroed before
unclamping. The EVD should be kept unclamped during transport of the patient