Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2009 Dec;65(6):E1212-3; discussion E1213. doi: 10.1227/01.NEU.0000359222.97354.84.
Cephalad migration of an indwelling intrathecal catheter within the spinal canal has rarely been described. Cranial subarachnoid hemorrhage (SAH) related to movement of this type of catheter has not been described. We report a case of SAH coincident with the migration of a free fragment of a baclofen pump catheter into the prepontine cistern.
A baclofen pump system was removed from a 47-year-old man with spasticity related to multiple sclerosis. A section retained in the spinal canal extended up to the T9 level. Ten days after the pump and lower portion of the catheter were removed, the patient presented with a severe headache and a classic aneurysmal pattern of SAH. The patient's catheter was found to have migrated adjacent to the basilar artery at the level of the superior cerebellar artery. An extensive evaluation, including computed tomography angiography, digital subtraction angiography performed twice, magnetic resonance imaging, and magnetic resonance angiography, showed no apparent cause for the hemorrhage. Initially, the catheter was left in place. However, 5 months after the SAH, the patient elected to have the catheter removed.
The catheter was pulled out from below through a C6-C7 laminoplasty without complications. The patient made an excellent recovery.
Cephalad catheter migration is a rare phenomenon. The mechanism of rostral migration remains unclear. The forces that propel a free fragment of catheter under these circumstances seem to be sufficient to cause a small vessel to rupture and bleed. Given the lack of an observed arterial injury, we postulate that venous bleeding caused this hemorrhage.
椎管内留置的鞘内导管向头端迁移的情况很少见。与这种类型的导管移动相关的颅后蛛网膜下腔出血（SAH）尚未见报道。我们报告了一例与巴氯芬泵导管游离碎片迁移到桥前池相关的 SAH 病例。
一名多发性硬化相关痉挛患者的巴氯芬泵系统被移除。保留在椎管内的一节导管延伸至 T9 水平。在泵和导管下段被移除 10 天后，患者出现严重头痛和典型的动脉瘤性 SAH 模式。发现患者的导管在靠近基底动脉的小脑上动脉水平处迁移。包括计算机断层血管造影、两次数字减影血管造影、磁共振成像和磁共振血管造影在内的广泛评估未发现出血的明显原因。最初，导管被保留在原位。然而，在 SAH 发生 5 个月后，患者选择将导管取出。
通过 C6-C7 椎板切除术从下方将导管拔出，无并发症。患者恢复良好。
导管向头端迁移是一种罕见现象。向头端迁移的机制尚不清楚。在这种情况下，推动导管游离碎片的力似乎足以导致小血管破裂和出血。鉴于未观察到动脉损伤，我们推测静脉出血导致了这种出血。
