Intracranial migration of a fractured intrathecal catheter from a baclofen pump system: Case report and analysis of possible causes

Todd A. Maugans

Research output: Contribution to journalArticle

Abstract

Objective: This case report describes a new complication associated with a baclofen pump in which its fractured intrathecal catheter migrated into the patient's ventricular system. A thecal model was developed to evaluate catheter buoyancy in artificial cerebrospinal fluid (CSF). The literature was reviewed to identify possible mechanical and physiologic causes of catheter migration. Clinical Presentation: A 16-year-old boy with cerebral palsy presented with cervical pain, nausea, and vomiting. He was known to have a nonfunctioning baclofen pump with a 1-piece intrathecal catheter. Imaging studies showed mild ventriculomegaly and a fractured segment of the intrathecal catheter that extended from the cervical subarachnoid space into the third and fourth ventricles. Intervention: The patient had complete symptom resolution after undergoing urgent surgical removal of the catheter segment. Manufacturer analysis of the retrieved catheter revealed a crushed, jagged proximal end. In an experimental thecal sac model, catheter segments in lengths of 0.5 to 89 cm were denser than the artificial CSF and, therefore, did not float in the thecal sac. This finding negates the role of buoyancy in migration. Review of the literature advocates for caudocranial CSF flow patterns as a plausible mechanism for migration. Conclusion: This complication alerts surgeons to the migration risk of loose intrathecal catheter segments into the ventricular system. CSF flow patterns and mechanical processes, but not material properties of the catheter, are likely causes.

Original languageEnglish (US)
Pages (from-to)319-322
Number of pages4
JournalNeurosurgery
Volume66
Issue number2
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

Fingerprint

Baclofen
Catheters
Cerebrospinal Fluid
Mechanical Phenomena
Fourth Ventricle
Subarachnoid Space
Third Ventricle
Neck Pain
Cerebral Palsy
Nausea
Vomiting

Keywords

  • Baclofen pump
  • Cerebrospinal fluid flow
  • Complications
  • Intrathecal catheter
  • Thecal sac

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Intracranial migration of a fractured intrathecal catheter from a baclofen pump system : Case report and analysis of possible causes. / Maugans, Todd A.

In: Neurosurgery, Vol. 66, No. 2, 01.02.2010, p. 319-322.

Research output: Contribution to journalArticle

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