Introduction: External Ventricular Drainage (EVD) is a critical neurosurgical procedure used for managing intracranial pressure in conditions like hydrocephalus and traumatic brain injuries. In low- and middle-income countries, the high cost of commercial EVD systems limits access to timely care, prompting the use of improvised, low-cost alternatives. However, evidence is needed to establish the safety and reliability of these handmade systems. This systematic review aims to evaluate the safety, effectiveness, and cost-efficiency of handmade EVD systems in low-resource settings, comparing them to prefabricated EVD systems. The focus is on clinical outcomes, infection rates, and the financial feasibility of handmade alternatives.
Methods: A comprehensive literature search was conducted across multiple databases, yielding 10,774 initial studies. After screening and eligibility assessment, five studies met the inclusion criteria. Data extraction focused on the materials used, assembly techniques, cost analysis, and clinical outcomes of handmade EVD systems compared to prefabricated systems.
Results: The five studies included in this review involved a total of 338 patients from Spain, Tunisia, Nigeria, Nepal, and Ethiopia. Handmade EVD systems varied widely in materials and methods, including the use of central venous catheters, feeding tubes, and urine collection bags. Costs ranged from under $5 to $20 USD, significantly lower than the prefabricated systems, which cost up to $485 USD. Infection rates and complications between handmade and prefabricated systems showed no statistically significant differences, suggesting comparable safety profiles.
Conclusion : Handmade EVD systems offer a viable, cost-effective alternative to prefabricated systems, especially in resource-limited settings. These findings support the broader adoption of handmade EVDs as a temporary solution where commercial systems are unaffordable or unavailable. Further research is recommended to standardize assembly techniques and ensure quality control.
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