Title: Rapid Versus Gradual Weaning of External Ventricular Drain after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis of Randomized and Non-Randomized Studies
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
An external ventricular drain (EVD) insertion is among the most frequently performed neurosurgical procedures. It remains unclear whether the weaning method, either gradual or rapid, influences the rate of ventriculoperitoneal shunt (VPS) insertions.
Objectives
This study aims to systematically review the literature comparing gradual and rapid EVD weaning in relation to the VPS insertion rate.
Methods
PubMed, Cochrane Central, and ScienceDirect were searched from inception till May 2025. The Randomized controlled trials and cohort studies comparing gradual and rapid EVD weaning in patients with subarachnoid hemorrhage (SAH) were included in this analysis. The primary outcome was the rate of VPS insertion, while secondary outcomes included the rate of EVD-associated infections and the duration of hospital and ICU stays. The quality assessment was conducted using the Cochrane risk of bias (RoB 2.0) tool and the Newcastle-Ottawa Scale. Publication bias was assessed visually through the funnel plots and statistically through Egger’s regression test.
Results
Five studies, pooling a total of 1,744 patients, were included in this meta-analysis. The VPS insertion rate was low in the rapid EDV weaning, but the results were statistically insignificant (RR = 0.86; 95% CI: [0.59, 1.27]; p = 0.46; I2 = 81%). Similarly, the EVD-associated infections were comparable between the two groups (RR= 0.83;95%CI:[0.50,1.40];p=0.49; I2=51%). However, the length of ICU (MD = -2.94 days; 95% CI: [-3.80, -2.08]; p < 0.00001; I2 = 0%) and hospital (MD = -4.55 days; 95% CI: [-7.14, -1.95]; p = 0.0006; I2 = 62%) stays were significantly shorter in the rapid EVD weaning group.
Conclusions
Rapid EVD weaning was comparable to gradual EVD weaning in terms of VPS insertion rates and EVD-related infections, but it significantly shortens the duration of hospital and ICU stays.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Rapid Versus Gradual Weaning of External Ventricular Drain after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis of Randomized and Non-Randomized Studies. CNS Annual Meeting 2025;2025:6913. https://www.cns.org/poster-search?id=6913
Figure. Forest plot comparing rapid versus gradual external ventricular drain weaning after subarachnoid hemorrhage across randomized and non-randomized studies.