Lumbar drainage (LD) serves as a vital diagnostic and therapeutic intervention in neurosurgery. Its key role involves the gradual, sustained, and effective removal of pathological cerebrospinal fluid, such as hemorrhagic or inflammatory cerebrospinal fluid, from the intracranial compartment. By facilitating the generation of fresh cerebrospinal fluid and reestablishing physiological cerebrospinal fluid circulation, this procedure accelerates cerebrospinal fluid normalization. This process not only optimizes short-term treatment outcomes but also helps reduce the long-term risk of hydrocephalus. Furthermore, the external lumbar drain enables continuous intracranial pressure monitoring and permits intrathecal medication delivery, extending its utility to both diagnostic and therapeutic domains. The technique is extensively employed in managing common neurosurgical conditions including subarachnoid hemorrhage, intraventricular hemorrhage, and intracranial infections, where it has demonstrated considerable clinical effectiveness. Despite its evident clinical value, post-procedural complications such as cerebrospinal fluid leakage and intracranial infection remain significant challenges, often discouraging broader adoption of this method. In response, the tunneled lumbar drainage (TLD) has been introduced to mitigate these risks. This review examines the clinical applications of TLD in neurosurgical practice, with the objective of offering evidence-based insights to enhance clinical management. The aim is to promote efficient drainage of abnormal cerebrospinal fluid while minimizing associated complications, ultimately contributing to improved patient outcomes in both the immediate and extended postoperative periods.