Hoederath P, Gautschi O P, Land M, Hildebrandt G, Fournier J Y
Department of Neurosurgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
Cent Eur Neurosurg. 2010 Feb;71(1):39-42. doi: 10.1055/s-0029-1202359.
The formation of catheter tip granulomas is an increasingly observed serious complication of intrathecally administered medication. This complication, which is frequently associated with neurological disturbances, has previously been attributed to high dosages and high concentrations of intrathecal morphine. Much less commonly, intrathecal hydromorphone and intrathecal baclofen have also been associated with intrathecal granuloma formation. In the current case, we report a patient who developed her fi rst catheter tip granuloma after 20 months of intrathecal morphine. After surgical granuloma removal and installation of a new catheter, the patient received intrathecal ziconitide for an interim period of six months. Because of a progressive inefficacy, ziconitide was replaced by hydromorphone. One month later, only nine months after the fi rst operative granuloma removal, a new catheter tip granuloma required a further surgical intervention. This case report highlights the potential of intrathecal morphine and hydromorphone to form consecutive inflammatory granulomas within the same patient. To the best of our knowledge, this is the fi rst report of a patient developing two consecutive catheter tip granulomas within nine months.
导管尖端肉芽肿的形成是鞘内给药越来越常见的严重并发症。这种并发症常伴有神经功能障碍，以前被认为与鞘内注射高剂量和高浓度吗啡有关。鞘内注射氢吗啡酮和鞘内注射巴氯芬也较少与鞘内肉芽肿形成有关。在本病例中，我们报告了一名患者，在鞘内注射吗啡20个月后出现了首个导管尖端肉芽肿。手术切除肉芽肿并植入新导管后，患者接受了为期6个月的鞘内注射齐考诺肽。由于疗效逐渐降低，齐考诺肽被氢吗啡酮替代。1个月后，即首次手术切除肉芽肿仅9个月后，新的导管尖端肉芽肿需要再次进行手术干预。本病例报告强调了鞘内注射吗啡和氢吗啡酮在同一患者体内形成连续性炎性肉芽肿的可能性。据我们所知，这是首例患者在9个月内出现两个连续性导管尖端肉芽肿的报告。
