Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA;Clinica del Dolor de Madrid, Madrid Spain; Pacific Pain Treatment Centers, San Francisco, California, USA.
Neuromodulation. 1998 Jul;1(3):137-48. doi: 10.1111/j.1525-1403.1998.tb00007.x.
OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal drug delivery systems is particularly distressing. An attempt was made to determine the extent of this problem in both reported and in heretofore unreported cases. Methods. A survey was mailed to 3269 implanters of intraspinal infusional systems to identify new cases of neurological sequelae of pump Implantation. 519 out of 3269 surveys mailed out responded. Results. There were 488 "no" respondents and 31 "yes" respondents to the question: "did any patient of yours develop neurologic sequelae or granulomatous catheter mass formation after implant of their intraspinal catheters?" 6 new, heretofore unreported cases of granulomatous mass formations at catheter tips were reported. 27 cases of neurological sequelae due to other etiologies were also noted. Also presented in this paper are 4 case reports to augment reader understanding of the problem. Conclusions. The problem of post-implant neurological sequelae is potentially devastating. Increased vigilance for early diagnosis may prevent the development of permanent paralysis. Gadolinium enhanced MRI scanning at the catheter tip is the imaging study of choice for diagnosis. Any patient developing a new area of pain, weakness or rapid escalation in intrathecal drug dose should be thoroughly assessed.
目的。脊髓内药物输送系统植入后发生神经后遗症尤其令人痛苦。我们试图确定已报道和未报道病例中这一问题的程度。
方法。我们向 3269 名脊髓内输注系统植入者邮寄了一份调查，以确定新的泵植入后神经后遗症病例。3269 份邮寄问卷中有 519 份作出了回应。
结果。在“你的患者中有因脊髓导管植入而出现神经后遗症或肉芽肿性导管肿块形成的吗？”这个问题上，有 488 份“否”和 31 份“是”的回复。报告了 6 例新的、以前未报道的导管尖端肉芽肿性肿块形成病例。还注意到 27 例因其他病因引起的神经后遗症病例。本文还介绍了 4 例病例报告，以增强读者对该问题的理解。
结论。植入后神经后遗症的问题具有潜在的破坏性。提高对早期诊断的警惕性可能预防永久性瘫痪的发生。在导管尖端进行钆增强 MRI 扫描是诊断的首选影像学检查。任何出现新的疼痛、无力或鞘内药物剂量快速增加的患者都应进行彻底评估。
