That's a great thought, as many forget that this is a viable option (taking into account Monro Kellie etc., removing CSF volume will leave space for the other compartments). Technically, per Stocchetti and Maas 2014, this is listed as the step to take after an increase in sedation but before hyperosmolar therapy is utilized. However, if an EVD isn't already in place, it's more practical to try using hyperosmolar therapy first, as we can give it essentially immediately and don't need to take the time to drop in an EVD. You should definitely continue to remember to consider CSF diversion early, however, which seems counterintuitive at first glance. Another consideration is whether or not it's feasible to place an EVD-- for example, if the patient already has slit ventricles, correct placement itself may be difficult, and the benefit of CSF drainage is likely to be much lower.
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