Lew Sean M, Psaty Estee L, Abbott Rick
Division of Pediatric Neurosurgery, Children Hospital of Wisconsin/ Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Neurosurgery. 2005 Mar;56(3):E624; discussion E624.
Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose.
An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space.
The spinal catheter was subsequently revised, and the patient made a full recovery.
The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.
鞘内注射巴氯芬治疗痉挛已应用近20年，取得了很大成功。已描述了多种并发症和陷阱。本报告详细介绍了一种新的并发症，即脊髓导管意外且最初未被识别地穿入硬膜下间隙，最终导致用药过量。
为一名患有痉挛的15岁女孩植入了鞘内泵系统。这最初导致治疗效果不佳。诊断检查最终导致通过泵系统注入造影剂，当硬膜下腔隙中隔离的药物释放到鞘内空间时，引发了巴氯芬用药过量。
随后对脊髓导管进行了修正，患者完全康复。
对于植入泵后尽管增加剂量仍出现药物效果不佳的患者，鉴别诊断应考虑硬膜下导管的可能性。由于存在自发或诱发用药过量的风险，需要密切监测，当硬膜下腔隙与鞘内腔隙之间出现连通时，可能会发生用药过量。
