• Brahim Kammoun, Fatma Kolsi, Mehdi Borni, Anis Abdelhedi, Souhir Abdelmouleh, Firas Jarraya, Oussama Bouhamed, Omar Kammoun, Emna Elleuch, and Mohamed Zaher Boudawara.
• Department of Neurosurgery, Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia. Electronic address: kammoun.brahim28@gmail.com.
• World Neurosurg. 2018 Nov 1; 119: 428-436.

ObjectiveExternal 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 materials to check the real-world applicability of the same device in the management of acute hydrocephalus and its effectiveness and safety.MethodsWe 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 presenting with acute hydrocephalus and requiring EVD.ResultsDuring 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 patients (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.ConclusionsThe 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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