Bergenheim A Tommy, Wendelius Margareta, Shahidi Saeed, Larsson Eva
Department of Neurosurgery, University Hospital, Umeå, Sweden.
Pediatr Neurosurg. 2003 Oct;39(4):218-21. doi: 10.1159/000072476.
Patients with myelomeningocele may often suffer from severe spasticity. Surgical treatment of the underlying pathology such as hydromyelia and tethered cord may be successful, but failures are not uncommon. Those cases may offer a surgical challenge since further therapeutic options are limited. We present the case of a 7-year-old boy with myelomeningocele and related conditions suffering from severe spasticity and pain in his lower limbs. Surgical efforts with untethering and posterior fossa decompression failed to improve the symptoms. A test with 25 microg intrathecally delivered baclofen showed a total relief of spasticity and pain so that a pump for continuous baclofen delivery was implanted. During 32 months of follow-up, his spasticity has been under excellent control on 55-157 microg baclofen per day. Continuous delivery of intrathecal baclofen may be a surgical option to consider in patients with myelomeningocele and severe spasticity.
脊髓脊膜膨出患者常伴有严重痉挛。针对诸如脊髓积水和脊髓拴系等潜在病理状况的手术治疗可能成功，但手术失败的情况也并不罕见。由于进一步的治疗选择有限，这些病例可能带来手术挑战。我们报告一例7岁患有脊髓脊膜膨出及相关病症的男孩，其下肢存在严重痉挛和疼痛。松解拴系及后颅窝减压的手术未能改善症状。鞘内注射25微克巴氯芬的试验显示痉挛和疼痛完全缓解，因此植入了持续输注巴氯芬的泵。在32个月的随访期间，他的痉挛通过每日55 - 157微克巴氯芬得到了良好控制。对于脊髓脊膜膨出和严重痉挛患者，鞘内持续输注巴氯芬可能是一种可供考虑的手术选择。
