Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA.
Neurosurgery. 2010 Feb;66(2):319-22. doi: 10.1227/01.NEU.0000363183.78323.D7.
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.
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.
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.
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.
本病例报告描述了一种与巴氯芬泵相关的新并发症，即其断裂的鞘内导管迁移至患者的脑室系统。建立了一个鞘内模型来评估导管在人工脑脊液（CSF）中的浮力。回顾文献以确定导管迁移的可能机械和生理原因。
一名 16 岁男孩因脑瘫出现颈痛、恶心和呕吐。已知他的巴氯芬泵不起作用，且有 1 段鞘内导管。影像学研究显示轻度脑室扩大和断裂的鞘内导管段从颈蛛网膜下腔延伸至第三和第四脑室。
患者在紧急手术切除导管段后完全缓解症状。制造商对取出的导管进行分析显示近端呈压碎、锯齿状。在实验性鞘内模型中，长度为 0.5 至 89 厘米的导管段比人工 CSF 密度更大，因此不会在鞘内漂浮。这一发现否定了浮力在迁移中的作用。文献回顾提倡尾向颅 CSF 流动模式作为迁移的可能机制。
这种并发症提醒外科医生注意松散的鞘内导管段迁移到脑室系统的风险。CSF 流动模式和机械过程，而不是导管的材料特性，可能是导致迁移的原因。
