Applicability, Safety, and Cost-Effectiveness of Improvised External Ventricular Drainage: An Observational Study of Tunisian Neurosurgery Inpatients Brahim Kammoun 1 , Fatma Kolsi 1 , Mehdi Borni 1 , Anis Abdelhedi 1 , Souhir Abdelmouleh 1 , Firas Jarraya 1 , Oussama Bouhamed 3 , Omar Kammoun 2 , Emna Elleuch 4 , Mohamed Zaher Boudawara 1 - OBJECTIVE: External ventricular drainage (EVD) is an emergent neurosurgical procedure. Many commercial sets are available for EVD that are not always obtainable in all hospitals. The aim of our study was to describe new techniques to perform EVD using simple improvised mate- rials to check the real-world applicability of the same device in the management of acute hydrocephalus and its effectiveness and safety. - METHODS: We illustrated 2 techniques for a “do it yourself” improvised EVD device using materials available even in non-neurosurgery-dedicated operating rooms. We performed an observational study in our institution (April 2015 to December 2016). We included all patients pre- senting with acute hydrocephalus and requiring EVD. - RESULTS: During a 20-month period, the new EVD device was used as a lifesaving solution for 33 patients. Good outcomes were noted in 11 of the 33 patients (33%). The EVD was complicated by fatal meningitis in 4 of the pa- tients (12%). Malfunction occurred in 6 patients. The new EVD device costs less than US$20 for the first technique and less than US$10 for the second technique. In contrast, the cost of a standard EVD set ranges from US$170 to US$380 in Tunisia. - CONCLUSIONS: The new EVD device has the potential to improve the quality of efficiency of care in difficult economic times that have changed the medical landscape, because it is both easy to make and cost-effective. Because it is an inexpensive technique, it could also be suitable for low-income countries, where neurosurgery is not yet the first and foremost health priority. INTRODUCTION T he placement of an external ventricular drainage (EVD) device is one of the most elementary and most common neurosurgical procedures worldwide. 1-3 It is used as an emergency treatment for acute hydrocephalus, increased intra- cranial pressure (ICP), and temporary cerebrospinal fluid (CSF) diversion in patients with craniocerebral infection. 4-8 EVD must be emergently performed when acute hydrocephalus or increased ICP has been diagnosed. EVD consists in placing an intraventricular catheter connected to an external drainage device. Many commercial sets are available to perform this procedure. However, these sets are not obtainable in all hospitals, especially those lacking neurosurgical departments. In addition, the clinical condition of patients waiting for transfer to a specialized center can deteriorate. As a rescue solution, we have described 2 tech- niques of a “do it yourself” improvised EVD device using materials available even in non-neurosurgeryededicated operating rooms. The EVD device can also be used at the bedside in intensive care units. This new EVD device is effective and less expensive than commercial sets. Therefore, it could be suitable for low-income countries, where cost pressures have necessitated such creative approaches and where neurosurgery is not yet a health priority. Key words - Acute hydrocephalus - CSF drainage device - External ventricular drainage - Technique Abbreviations and Acronyms CSF: Cerebrospinal fluid EVD: External ventricular drainage ICP: Intracranial pressure From the Departments of 1 Neurosurgery and 2 Radiology, Habib Bourguiba University Hospital, Sfax University, Sfax; 3 Department of Anesthesiology, Habib Bourguiba Hospital of Mednine, Sfax University, Mednine; and 4 Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax University, Sfax, Tunisia To whom correspondence should be addressed: Brahim Kammoun, M.D. [E-mail: kammoun.brahim28@gmail.com] Supplementary digital content available online. Citation: World Neurosurg. (2018) 119:428-436. https://doi.org/10.1016/j.wneu.2018.07.261 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. 428 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2018.07.261 Doing More with less