Fig 1.
Postoperative imaging manifestations of patients in the EVD group.
EVD group: A catheter was placed in the lateral ventricle via Kocher point before craniotomy. Reprinted from Tianjin huanhu hospital under a CC BY license, with permission from Plos one, original copyright 2025.
Fig 2.
Postoperative imaging manifestations of patients in the EVD + CD group.
EVD + CD group: EVD was finished before craniotomy, and a catheter was inserted in the prepontine cistern after the optico-carotid cistern. Reprinted from Tianjin huanhu hospital under a CC BY license, with permission from Plos one, original copyright 2025.
Fig 3.
Procedure for cisternal drain placement.
a. Optico-carotid Cistern, b. Optic nerve ipsilateral, c. Internal Carotid Artery (ICA), d. Optic nerve contralateral, e. Anterior Cerebral Artery (ACA), f. Optic-Chiasm, g.Clipping. The image acquired following the opening of the optico-carotid cistern with the internal carotid artery (ICA), optic nerve (ON), and Liliequist’s membrane is depicted in this figure. Observe how the catheter is positioned between the internal carotid artery (ICA) and the optic nerve (ON), traveling through Liliequist’s membrane and into the prepontine cistern. Reprinted from Tianjin huanhu hospital under a CC BY license, with permission from Plos one, original copyright 2025.
Fig 4.
Postoperative intracranial pressure monitoring.
ICP Monitoring: While cisternal drainage enabled continuous CSF drainage with sporadic pressure readings, external ventricular drainage offered constant pressure monitoring. ICP on postoperative days 1, 3, 5, and 7, as determined by the two approaches, does not significantly differ statistically. Reprinted from Tianjin huanhu hospital under a CC BY license, with permission from Plos one, original copyright 2025.
Fig 5.
Changes in cerebrospinal fluid characteristics and biomarkers.
A and B: cell count and protein content of CSF. D-F: Changes in inflammatory factors. G-I: Changes of vascular endothelial cell injury factors. C: Different characteristics of CSF in the two groups. From those pictures, we could infer that cisternal drainage could enhance hemorrhagic/inflammatory CSF clearance. (*p < 0.05, **p < 0.01). Reprinted from Tianjin huanhu hospital under a CC BY license, with permission from Plos one, original copyright 2025.
Table 1.
Clinical data of aneurysmal subarachnoid hemorrhage (aSAH) (47 patients).