Neurological Surgery No Shinkei Geka Volume 45, Issue 1 (January 2017)
Japanese

A Pediatric Case of Intractable Cerebrospinal Fluid Leakage after Implantation of an Intrathecal Baclofen Pump Akitsugu MORISHITA 1 , Hideo AIHARA 1 , Tomoaki NAKAI 1 , Masao ADACHI 2 1Department of Neurosurgery, Hyogo Prefectural Kakogawa Medical Center 2Adachi Child Clinic Keyword: intrathecal baclofen , cerebrospinal fluid leak , edema , occult hydrocephalus pp.33-38
Published Date 2017/1/10
DOI https://doi.org/10.11477/mf.1436203444
  • Abstract
  • Look Inside
  • Reference

 Intrathecal baclofen(ITB)infusion can offer a useful treatment for severe spasticity;however, numerous complications have been reported. We report a pediatric case in which intractable cerebrospinal fluid(CSF)leakage associated with several inconvenient symptoms arose after implantation of the ITB pump system.

 A 10-year-old girl with spastic quadriparesis and athetoid cerebral palsy underwent implantation of an ITB delivery system. After discharge, she presented with fluid collection surrounding the pump in the abdomen. The volume of fluid increased and was percutaneously aspirated every other week. However, conservative management failed to relieve fluid collection, which was suspected to be due to CSF leakage.

 She underwent additional purse-string suture of the point inserted catheter insertion in the back, epidural blood patch, and subfascial implantation of an anchor. However, none of these therapies proved effective. Progressive enlargement of the accumulated fluid was observed. Furthermore, symptoms of ITB withdrawal appeared.

 Lumbar-peritoneal shunting was performed, and the subcutaneous fluid collection was relieved postoperatively. The course after shunting was uneventful;hence, the dose of baclofen was stabilized. No recurrence of fluid collection was encountered for two years. Intractable CSF leakage was thought to be caused by wasting, occult hydrocephalus, and twisted movements. This case indicates that care is required in the management of CSF leakage after ITB pump implantation.


Copyright © 2017, Igaku-Shoin Ltd. All rights reserved.

基本情報

03012603.45.1.jpg
Neurological Surgery 脳神経外科
45巻1号 (2017年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

関連文献

もっと見る

文献を共有