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Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (<jats:italic>N<\/jats:italic>\u2009=\u200919) patients in the proximal and in 89.5% (<jats:italic>N<\/jats:italic>\u2009=\u200917) in the distal catheter. The distal catheter tip was detectable in 27.7% (<jats:italic>N<\/jats:italic>\u2009=\u20095) patients. Free intraabdominal fluid was initially detected in 21.4% (<jats:italic>N<\/jats:italic>\u2009=\u20094) patients and in 57.9% (<jats:italic>N<\/jats:italic>\u2009=\u200911) at the end of the examination (<jats:italic>P<\/jats:italic>\u2009=\u20090.049). ONSD was significantly lower after pump activation (4.4\u2009\u00b1\u20090.9\u00a0mm versus 4.1\u2009\u00b1\u20090.8\u00a0mm, <jats:italic>P<\/jats:italic>\u2009=\u20090.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2\u2009\u00b1\u200945.2 versus 5.6\u2009\u00b1\u20093.7\u00a0cm\/sec, <jats:italic>P<\/jats:italic>\u2009=\u20090.015; 16.6\u2009\u00b1\u20099.5\u00a0ml\/sec versus 5.1\u2009\u00b1\u20094.0\u00a0ml\/sec, <jats:italic>P<\/jats:italic>\u2009=\u20090.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (<jats:italic>P<\/jats:italic>\u2009=\u20090.975) or PD (<jats:italic>P<\/jats:italic>\u2009=\u20090.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system.<\/jats:p>","DOI":"10.1007\/s10143-024-02665-w","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T10:02:17Z","timestamp":1725271337000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Superb microvascular ultrasound is a promising non-invasive diagnostic tool to assess a ventriculoperitoneal shunt system function: a feasibility study"],"prefix":"10.1007","volume":"47","author":[{"given":"Konstantin","family":"Brawanski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2258-1032","authenticated-orcid":false,"given":"Ondra","family":"Petr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian Preuss","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus","family":"K\u00f6gl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudius","family":"Thom\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elke R.","family":"Gizewski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannes","family":"Gruber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Verius","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonhard","family":"Gruber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Putzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,2]]},"reference":[{"key":"2665_CR1","doi-asserted-by":"crossref","first-page":"e505","DOI":"10.1016\/j.wneu.2019.10.108","volume":"134","author":"S Ahmadvand","year":"2020","unstructured":"Ahmadvand S, Dayyani M, Etemadrezaie H et al (2020) Rate and risk factors of early ventriculoperitoneal shunt revision: a five-year retrospective analysis of a Referral Center. 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Our trial was approved by the local ethics committee of the Medical University Innsbruck, Austria (AN EK Nr: 1300\/2020). Prior to initial examination, all patients were thoroughly informed in advance. Thereafter, written informed consent was subsequently obtained from every patient according to Austrian legislation. Of note, every patient granted both consent to participate and consent to publish.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"521"}}