Related Experiment Video
Updated: Jul 29, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Use of a Prophylactic Retrograde-Flushing Device in High-Risk Pediatric Patients with Ventriculoperitoneal Shunts: A
Michael Vinzani1, Mohammed Alshareef2, Ramin Eskandari2
1College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
A new ReFlow device and flushing protocol significantly reduced proximal shunt occlusions in pediatric hydrocephalus patients. This innovation offers a promising solution to prevent common and dangerous ventriculoperitoneal shunt (VPS) failures.
Area of Science:
- Neurosurgery
- Biomedical Engineering
- Pediatric Neurology
Background:
- Ventriculoperitoneal shunts (VPS) have high malfunction rates, particularly proximal occlusion in posthemorrhagic hydrocephalus (PHH) patients.
- Obstruction is commonly caused by debris, protein, and cellular ingrowth.
- Existing preventative methods for shunt occlusion lack demonstrated efficacy.
Purpose of the Study:
- To describe the use of a novel retrograde proximal flushing device (ReFlow) and prophylactic flushing protocol.
- To evaluate the device's efficacy in maintaining ventricular catheter patency and reducing proximal shunt occlusions in pediatric patients.
- To present technical details and case series data on the ReFlow device implantation and protocol.
Main Methods:
- A case series of 9 pediatric patients with PHH undergoing ReFlow device implantation and prophylactic flushing.
- Data collected over a 2.8-4 year follow-up period.
- Analysis of pre- and postimplantation proximal shunt obstruction rates.
Main Results:
- All 9 patients had PHH, with an average age of 5.6 years.
- Following ReFlow implantation and prophylactic flushing, proximal shunt failures reduced from 14 in the preceding 2 years (in 7 patients) to only 1 in all 9 patients during the follow-up period.
- Prophylactic flushing was initiated between 2 and 14 days post-implantation and continued throughout the follow-up.
Conclusions:
- The ReFlow device combined with prophylactic flushing shows potential in reducing proximal obstruction and the need for revision surgery in pediatric VPS.
- This approach may mitigate the high rates of proximal catheter occlusion, emergency surgeries, and associated morbidity/mortality.
- Further investigation with larger patient cohorts and longer follow-up is warranted to confirm long-term safety and efficacy.
Introduction:
Ventriculoperitoneal shunt (VPS) malfunction rates are as high as 40% in the first year with posthemorrhagic hydrocephalus (PHH) patients having the highest proximal occlusion risk. Debris, protein, and cellular ingrowth most commonly obstruct the proximal ventricular catheter and/or valve. Historically, no preventative methods have demonstrated efficacy. We present a technical note and case series describing the use of a retrograde proximal flushing device and prophylactic flushing protocol to maintain ventricular catheter patency and reduce proximal shunt occlusions.
Methods:
We present our 2.8-4-year follow-up data on the first 9 pediatric cases of ReFlow (Anuncia Inc, Scottsdale, AZ) device implantation combined with routine prophylactic flushing. Rationale for device implantation, patient selection, surgical procedure details, postoperative follow-up, and prophylactic flushing protocol are discussed as well as pre- and postimplantation ventricular catheter obstruction rates. We include a technical note on the device setup and prophylactic flushing protocol.
Results:
Patient average age was 5.6 years and all patients had PHH. Minimal follow-up was 2.8 years (range 2.8-4 years). Prophylactic flushing was initiated between 2 and 14 days after ReFlow implantation and has continued as of the last follow-up. In 7 patients, ReFlow implantation occurred during the revision of an existing shunt and in two, implantation was coincident with initial VPS placement. In the 2 years preceding ReFlow and prophylactic flushing, 14 proximal shunt failures occurred in the 7 patients with existing VPS. This was reduced to only one proximal shunt failure in all 9 patients during the full follow-up period after ReFlow and prophylactic flushing.
Conclusion:
Pediatric VPS placement carries high rates of proximal catheter occlusion, often leading to emergency surgery, morbidity, or even death. The ReFlow device along with routine prophylactic flushing may reduce proximal obstruction and need for revision surgery. Higher patient numbers and longer follow-up periods are necessary to further elucidate the safety and effect of such a device on longer term shunt failures and revision surgery.
