The brains behind a new device that is reducing unnecessary surgeries – and saving lives

July 31, 2023
Teeny tiny newborn baby on mom's chest
Sutton Whitlock was born 16 weeks early. Weighing just 1 pound and 12 ounces, his prognosis was grim. But thanks to excellent care and innovative thinking, he's now a happy 7-year-old boy who's going into second grade this fall. Photo provided

The solution seems so simple the way he explains it.

But for a very long time, a basic flaw existed with shunts that left neurosurgeons, well, stumped. Because no matter how they were designed, most shunts – tubes that carry excess fluid off the brain, in turn relieving pressure – would eventually get clogged, rendering them useless. Naturally, this led to more problems, more surgeries and ironically, more headaches for patients and doctors alike. 

mugshot of eskandari 
Dr. Ramin Eskandari

That is until MUSC Health pediatric neurosurgeon Ramin Eskandari, M.D., had a chance meeting with a device maker in 2017. While attending a medical conference in Houston, Eskandari found himself in a room with a handful of other people, listening to a vendor talk about a new shunt-related implant. The device, the vendor said, when attached to an existing shunt, would allow doctors who encountered a patient with a blockage to simply push on it – much like you would on the cap of a handheld flashlight – and voila! Problem solved. 

“I thought, ‘Man, this thing looks amazing,’” Eskandari said, recalling that first encounter. “So I went over and looked at it and kind of played with it and listened to their spiel and then I asked, ‘How often do we have to push on this thing to prevent the blockage in the first place?’ And they kind of looked at me like I was speaking a totally different language.”

For a moment, the two sides looked at each other in stunned silence. Hanging in the air, the glimmer of a breakthrough. Eskandari’s next question, “Why wait until it’s blocked in the first place?” was the tipping point. The intellectual equivalent of the device itself, his query forced open the flow of a grand new idea: They could use the device proactively to prevent blockages from ever happening in the first place.

pull quote from neurosurgeon Ramin Eskandari that says "they kind of looked at me like was speaking a totally different language." 

In the six years since that “aha” moment between provider and manufacturer, the device – which was slightly modified to accomplish some of the things Eskandari said were necessary (like it needed to be softer, smaller, more symmetrical) – has gone through several iterations, received FDA approval and is now being used in patients all over the country.

The way it works is elegantly straightforward. At designated intervals (depending on the patient this could be twice a day, three times a week, etc.) the patient or family member quickly presses down on a raised dome through the skin, moving the fluid already inside the catheter which in turn dislodges any debris which might have accumulated on the catheter tip, preventing any sort of blockage from ever forming. 

a series of diagrams, one showing the reflow device by itself, another showing it connected to shunt system and where it is placed in the head and last is one showing how the reflow is pressed through the skin 
Top left, the ReFlow device, which is roughly the size of a fingertip, connects to the existing shunt valve system (top right). To operate it, a family member simply presses down on the slightly raised bump where the pump lies under the scalp and it clears any debris which might have collected in the shunt system, thus greatly lessening the need for surgeries due to shunt complications. Images provided

Because the idea bucked conventional wisdom at first – “I had so many colleagues say to me, ‘I’m not going to teach families to push on their shunts,’” Eskandari said – acceptance was slow. So he put his reputation where his mouth was, implanting the device in nine of his highest risk patients – patients who repeatedly needed surgeries for blocked shunts. As Eskandari suspected, time proved his faith to be well-placed. When used as directed, the device, which is now known as ReFlow (because it reverses the flow of the fluid inside the catheter), drastically reduced the number of subsequent surgeries for those patients. In the two years under Eskandari’s care before having ReFlow, the group had a collective 13 surgeries. In the four years after, just one. 

“We were just blown away,” he said.

Miranda Whitlock’s son Sutton was one of those first nine who Eskandari suggested might benefit from having a ReFlow implanted. Sutton, who was delivered 16 weeks early, weighed just 1 pound, 12 ounces at birth – about the weight of a pineapple.

a smiling young boy sitting in a restaurant, wearing a hat and holding a toy truck 
"This child would be a 2nd grade dropout if I’d let him because he knows what he wants to do," his mom said. "He wants to drive trucks on the highway, work excavators, bulldozers, you name it." Photo provided

“He was so tiny,” Miranda said. “His skin looked like it was see-through.”

For his first 141 days out of the womb, Sutton lived in a hospital. Premature babies often are at higher risk for health complications and Sutton was no different. During birth, due to his small size and the way he was oriented in the uterus, Sutton suffered a Grade 4 bilateral hemorrhage on his brain, leading to hydrocephalus, a chronic condition that often stays with the patient for the duration of his or her life. 

“His was, like, worst-case scenario, but even still, this kid was blessed,” Miranda said. Though Sutton suffered from some brain- and lung-related issues, he ate like a champ and just one month – to the day – after his original due date, he finally got to go home.

Unfortunately, as is typically the case with babies born with hydrocephalus, Sutton would make dozens of trips back to the doctor. By the time he was 4 years old, he had already undergone five surgical procedures to address shunt blockages. Each one of those was unbearable for Miranda. 

“Sutton would start throwing up; his heart rate would spike and his body would just shut down,” she said. “It was absolutely terrifying.”

So when Eskandari posed the idea of trying something different and new – in the shunt world, there had been no real changes to the way things had been done for nearly 70 years – Miranda didn’t hesitate: She wanted Sutton to get the ReFlow. 

“Anything that I could do to lessen the odds of him having another surgery was all I needed to hear. It was an easy yes,” she said. 

a young boy with a sparkler, standing in grass 
Less surgeries means less stress for Mom and more playtime for Sutton. Photo provided

Since the device was implanted in Sutton nearly three years ago, he’s only required one surgery. 

Miranda, a part-time dental assistant, said pushing the button on Sutton’s ReFlow is just part of their daily routine – “like brushing your teeth.” 

“I can’t overstate this enough: We finally feel like we’re in control of Sutton’s well-being. We get to be proactive, rather than just waiting for the next thing to go wrong.”

Sutton is 7 years old now and goes to Bonner Elementary School in Moncks Corner. According to Miranda, his cerebral palsy and mild cognition issues as a result of his premature birth are challenges, sure, but they don’t slow her son down one bit. 

“That is one wild, happy child,” she said.

As for Eskandari, he doesn’t just recommend the ReFlow for his highest-risk patients anymore but, rather, anyone who needs a shunt.

“The hope is that now, when we place a shunt, especially in babies,” he said, “they’ll never have to have another surgery again.”