Objective To explore the clinical effect of modified extraventricular drainage on severe tuberculous meningitis (TBM) and refractory hydrocephalus. Methods Clinical data of patients with severe TBM and refractory hydrocephalus in a hospital from 2013 to 2017 were analyzed, the modified extraventricular drainage was adopted, ventricular segment was punctured, then connected to the linear connector and abdominal segment shunt, pass through a subcutaneous incision in the abdomen, and continue to drain and purify the cerebrospinal fluid, after disease condition was stable, cerebrospinal fluid drainage device was removed or ventricular-abdominal shunt treatment was performed. The Evan's index, GCS score and GOS prognostic score of patients before and after treatment were compared. Results A total of 15 patients with severe TBM and refractory hydrocephalus were treated, aged from 19 to 64 years. Compared with before treatment, Evan's index and GCS score of patient after treatment were improved, differences were statistically significant (all P < 0.05). One case was removed extraventricular drainage tube after inflammation was controlled, and the other 14 cases underwent ventricular-abdominal shunt. According to the GOS classification at discharge, 13 cases (86.7%) recovered well (4-5 points), and 2 cases (13.3%) reco-vered poorly (3 points). Drainage time was 59-335 days, with an average of 173.3 days. There was no intracranial infection and shunt blockage complication during drainage. Patients were followed up for 2-5 years, with an ave-rage of 4.5 years, one case of ventricular segment of shunt tube was placed in the transparent septum space, which caused the ventricle to expand again, after fistulation through transparent septum and shunting again, it was cured, and the remaining cases were free of complications. Conclusion Modified extraventricular drainage can significantly improve the success rate of final shunt, especially for patients with severe TBM and refractory hydrocephalus after repeated treatment failure.