McMillan Marion R, Doud Thomas, Nugent W
Foothills Regional Pain Center and Mountainview Medical Imaging, Seneca, South Carolina, USA.
Anesth Analg. 2003 Jan;96(1):186-90, table of contents. doi: 10.1097/00000539-200301000-00039.
A cohort of seven patients receiving intrathecal analgesic drug therapy for chronic intractable pain underwent radiocontrast myelography and computed tomography (CT) scanning to screen for catheter-associated intrathecal masses. Three of seven patients examined had intraspinal masses associated with the tip of the drug infusion catheter after a total of 118 mo of therapy. The index case presented with exacerbation of neuropathic pain and paralysis of the left lower extremity. The two additional cases detected by CT myelography were asymptomatic at the time the catheter-associated mass was assessed. The mean duration of therapy before diagnosis of the catheter-associated mass was 19.6 mo, with a range of 16-25 mo. An intergroup comparison of demographic and treatment variables between patients, with and without catheter-associated masses, demonstrated that patients with masses were younger and were receiving a larger morphine dose than patients without masses. The differences were statistically significant (P = 0.05). In one patient with an asymptomatic catheter-associated intrathecal mass, regression of the mass was observed after cessation of therapy. In a second asymptomatic patient, the mass remained stable over 1 yr of continued treatment after substitution of hydromorphone for morphine without interruption of therapy. Neither asymptomatic patient has subsequently developed additional neurologic findings or injury after detection of occult catheter-associated intrathecal masses and clinical intervention. We suggest that all patients receiving long-term intrathecal analgesia should undergo periodic radiographic surveillance to further define their risk of developing occult catheter-associated masses and to allow intervention before neurologic injury can develop.
Catheter-associated intrathecal masses were detected in three of seven patients receiving long-term intrathecal analgesia. In the two asymptomatic patients, timely clinical intervention was associated with the avoidance of subsequent neurologic injury and spontaneous resolution of one of the occult masses.
一组七名因慢性顽固性疼痛接受鞘内镇痛药物治疗的患者接受了放射性造影脊髓造影和计算机断层扫描（CT）以筛查与导管相关的鞘内肿块。在总共118个月的治疗后，七名接受检查的患者中有三名出现了与药物输注导管尖端相关的椎管内肿块。首例患者表现为神经性疼痛加重和左下肢麻痹。在评估与导管相关的肿块时，通过CT脊髓造影检测出的另外两例患者无症状。在诊断与导管相关的肿块之前，治疗的平均持续时间为19.6个月，范围为16 - 25个月。对有和没有与导管相关肿块的患者的人口统计学和治疗变量进行组间比较，结果表明有肿块的患者比没有肿块的患者更年轻，且接受的吗啡剂量更大。差异具有统计学意义（P = 0.05）。在一名患有无症状导管相关鞘内肿块的患者中，治疗停止后观察到肿块消退。在第二名无症状患者中，在将氢吗啡酮替代吗啡且治疗未中断的情况下，持续治疗1年期间肿块保持稳定。在检测到隐匿性导管相关鞘内肿块并进行临床干预后，这两名无症状患者均未随后出现其他神经系统表现或损伤。我们建议所有接受长期鞘内镇痛的患者应定期进行影像学监测，以进一步明确其发生隐匿性导管相关肿块的风险，并在神经损伤发生前进行干预。
在七名接受长期鞘内镇痛的患者中，有三名检测出与导管相关的鞘内肿块。在两名无症状患者中，及时的临床干预与避免随后的神经损伤以及其中一个隐匿性肿块的自行消退有关。
