In Reply: Active Cerebrospinal Fluid Exchange vs External Ventricular Drainage in the Neurocritical Care Unit: An International, Retrospective Cohort Study

We thank Dr Lu for his kind words and enthusiasm for our work.1,2 As he points out, the applications for active cerebrospinal fluid (CSF) exchange extend well beyond the treatment of infection and intraventricular hemorrhage. CSF composition and circulation plays a major role in several currently treatment-resistant conditions including glioblastoma multiforme, leptomeningeal cancer (LMD), neurodegenerative disease, and many others. We have treated several cases of LMD with active CSF exchange at our institution (previously presented at Society for Neuro-Oncology, 2024, Houston, TX, USA) with promising early results. Active CSF exchange is a promising technique with wide applications. Because of that, we and others in this field are committed to a collaborative, multicenter approach to research and innovation. We encourage interested readers to consider joining the Active CSF Exchange Society (www.ACE-Society.org). This is a nonprofit medical society dedicated to research and education around this technique, with a focus on organizing collaborative research and early dissemination of best practices. Membership is free and open to all healthcare professionals with interest in the treatment of CSF and related diseases.