PMC7265405_01
(a) Intraoperative ultrasonography in burr hole probe's eye view demonstrating bilateral residual intraventricular hemorrhage (red arrowheads) along the lateral walls of the bilateral frontal ventricular horns with the ReFlow ventricular catheter (gray rectangle) within the left lateral ventricle (LV). (b) Lack of flow within the ventricular catheter with echoic densities (orange arrows). (c) Immediate single image post ReFlow flusher depressed, demonstrating extraluminal echogenic debris dispersing from the adjacent catheter inlet holes (yellow oval). (d) Ventricular clearance extraluminally (yellow oval) after few seconds and intraluminal CSF flow restored in anterograde flow (orange arrows).
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F1
We then under live ultrasonography placed the ReFlow ventricular catheter into the frontal horn of the left lateral ventricle and away from the remaining intraventricular hemorrhage along the lateral wall [Figure 1a]. With this concern, we manually depressed the ReFlow flusher device to generate a retrograde flush of CSF from the ReFlow CSF chamber to the ReFlow proximal catheter tip [Figure 1b] with evidence of immediate hyperechoic particles disengaging intraventricularly away from the catheter tip inlet holes under live intraoperative ventricular ultrasonography [Figure 1c]. Clearance of debris was identified and flow within the ventricular catheter was restored [Figure 1d].