Background: External ventricular drain (EVD) placement is one of the most commonly used interventions in life-saving neurosurgical care. EVDs are often used to treat traumatic brain injuries, infection, primary and secondary hydrocephalus, and intracranial space occupying lesions, such as tumors, cysts, and ischemic/hemorrhagic strokes. EVDs have been proven to reduce mortality but are often associated with complications that can affect patient outcomes. Our study investigates the patient outcomes associated with emergent EVD placement in a patient population with no prior history of neurosurgery. Methods: A retrospective chart review was performed on all patients 18+ requiring emergent EVD placement from January 2016 to December 2022 at Allegheny General Hospital in Pittsburgh, PA. Exclusion criteria included intra-operative EVD placements and patients with any prior neurosurgical history. 223 patient charts were analyzed for outcomes of independent ambulation capability, length of hospital stay, subsequent neurosurgical intervention, and final patient disposition. Subsequent neurosurgical interventions were stratified into six subcategories: EVD removal only, subsequent EVD placement, ventriculoperitoneal shunt (VPS) placement, endoscopic third ventriculostomy (ETV), craniotomy, and other. Patient disposition included home, inpatient rehab, skilled nursing facility, long-term acute care, hospice, and expiration. Results: Our study demonstrated that only 10% of patients were able to ambulate independently at discharge, 24% of patients required shunt placement, 20% of patients expired in hospital and the average length of hospital stay was 20 days. Conclusions Despite there being immense research demonstrating the efficacy and safety of EVDs, there is limited literature for clinicians and patients together to demonstrate the clinical gravity of EVD placement. Our study accurately delineates the clinical patient outcomes associated with EVD placement on neuro-surgically naive patients.

Traditional surgical techniques for extradural lumbar schwannomas are associated with considerable morbidity, including spinal instability and injury to the viscera and lumbar plexus. Minimally invasive approaches decrease soft tissue damage, blood loss, and postoperative length of stay. For select extraforaminal schwannomas, a minimally invasive lateral transpsoas approach affords a direct surgical corridor. A 53-year-old obese female presented with 1 year of left iliopsoas weakness and L3 radiculopathy refractory to conservative management. Lumbar spine magnetic resonance imaging revealed a contrast-enhancing mass within the left psoas muscle consistent with an extraforaminal L3 schwannoma. The patient underwent minimally invasive oblique retroperitoneal surgical resection. Intraoperatively, the nerve root was splayed over the superior-lateral portion of the tumor limiting us to subtotal resection with nerve root preservation. The patient had improvement of pain and weakness that persisted at a 3-month follow-up. A minimally invasive lateral/oblique transpsoas approach provides a direct surgical approach for extraforaminal schwannoma. Patient body habitus and the nerve root relationship to the tumor may present limitations for the safe extent of resection.