{orange:Overview}

This single-case report, peer-reviewed in Surgical Neurology International, documents the first direct intraoperative evidence that a proximal shunt obstruction can be cleared noninvasively using the ReFlow flusher. The case involved a 5-year-old boy who developed hydrocephalus following a cerebral arteriovenous malformation rupture and was treated with a ventriculoperitoneal shunt fitted with the ReFlow flusher assist device.

At the conclusion of the shunt placement, the surgical team noted that the shunt valve reservoir would not refill, a sign of proximal obstruction. They depressed the ReFlow flusher manually and observed the result under live intraoperative ultrasound.

{orange:Key Findings}

• At conclusion of placing VP shunt with ReFlow, the shunt valve reservoir was noted to not refill.
• After manual depression of the ReFlow flusher, identified clearance of debris from the obstructed ventricular catheter allowing reestablished CSF flow through the shunt system under live intraoperative ultrasonography. Subsequently, there was return of brisk refill to the shunt valve reservoir.

{orange:Clinical Relevance}

Reported direct intraoperative ultrasonographic evidence of ReFlow's retrograde flushing mechanism clearing debris from an obstructed ventricular catheter and restoring CSF flow through the shunt system. While limited to a single intraoperative case, the study supports the mechanistic rationale for ReFlow as a potential in situ approach to addressing proximal catheter obstruction.