ReviewNeurosurgical review2026
Handmade external ventricular drainage in resource-limited settings: safety, feasibility, and cost-effectiveness from a Peruvian cohort and global evidence review.
Review in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
16 authors.
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Abstract
External Ventricular Drainage (EVD) is essential in managing intracranial hypertension, but the high costs of prefabricated systems limit access in low- and middle-income countries (LMICs). Handmade alternatives have emerged as low-cost options, though evidence of their safety and effectiveness remains limited. This study assessed the clinical performance of handmade EVDs through a retrospective cohort analysis and a literature review. We conducted a retrospective cohort study at Hospital Nacional Daniel Alcides Carrión (Callao (Lima Metropolitan Area), Peru) from January 2021 to April 2023. Twenty-three patients received either Prefabricated (n = 12) or Improvised (n = 11) EVDs. Outcomes included central nervous system (CNS) infection and device replacement. Statistical analysis included bivariate and multivariable logistic regression. Additionally, a systematic literature search identified seven studies from Spain, Tunisia, Nigeria, USA/UK, Philippines, Nepal, and Ethiopia reporting on handmade EVDs. In the Peruvian cohort, CNS infections occurred in 6/12 (50.0%) prefabricated EVD cases and 4/11 (36.4%) handmade EVD cases (p = 0.51), and replacement was required in 5/12 versus 3/11 cases (p = 0.47). In multivariable logistic regression, improvised EVD use was not significantly associated with CNS infection (aOR = 0.70; 95% CI: 0.07–6.63). In the literature review (7 publications; 317 patients), handmade EVDs were assembled using accessible materials (e.g., feeding tubes and urinary bags), with costs ranging from <US$5 to €20 versus ~€485 for commercial devices, and reported heterogeneous but broadly comparable complication profiles. Including our cohort, the total evidence base comprised 340 patients. Handmade EVDs appear feasible and substantially less costly than prefabricated systems. In this small retrospective cohort, we did not detect a clear signal of increased infection or replacement compared with commercial EVDs, but estimates were imprecise and do not establish equivalence. Handmade systems may serve as a temporary bridging option when commercial kits are unavailable, pending prospective validation and standardized protocols.
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