External Ventricular Drainage Positioning in Intraventricular Hemorrhage: With More Blood in the Ventricles, is the Resolution Faster?

Intraventricular hemorrhage (IVH) is a condition linked to high rates of morbidity and mortality. External ventricular drainage (EVD) is commonly used to treat it, particularly in cases of obstructive hydrocephalus. Placing the EVD in the ventricle with the most considerable clot burden may improve the effectiveness of blood clearance, especially when combined with intraventricular thrombolysis using a tissue plasminogen activator. This paper explores the physiological rationale, indications, and clinical considerations for preferentially placing the EVD in the “bloodier” ventricle to enhance IVH resolution.