Southwell Derek G, Osorio Joseph A, Liverman Christopher S, Friedman Lauren M, Naidu Ramana K, Poree Lawrence R, Henry Melanie M, Jacques Line
Department of Neurological Surgery, University of California, San Francisco, California, USA.
Department of Pathology, University of California, San Francisco, California, USA.
Surg Neurol Int. 2017 Jul 25;8:159. doi: 10.4103/sni.sni_80_17. eCollection 2017.
Catheter-associated inflammatory masses (CIMs) are a rare but serious complication of intrathecal drug delivery devices. CIM formation is influenced by local medication concentration, which is determined in part by flow dynamics at the catheter tip. Underlying spinal pathologies, such as neoplasms, may alter flow at the catheter tip, thereby contributing to CIM formation. Moreover, they may also complicate the clinical and radiologic diagnosis of a CIM.
A 36-year-old man with neurofibromatosis type 1 presented to our emergency department with complaints of increased back pain and leg weakness. To treat pain secondary to his multiple spinal masses, he had previously undergone placement of an implantable drug delivery system, which infused a compounded drug of fentanyl and bupivacaine. Imaging studies depicted numerous masses consistent with neurofibromatosis, including a compressive mass located circumferentially at the porous catheter terminus and proximal to the catheter tip. Surgical removal of this mass was performed; pathologic findings were consistent with a catheter tip granuloma.
In the described case, CIM formation likely resulted from a combination of, 1) an unusually high fentanyl concentration, and, 2) altered infusate flow due to spinal neurofibromas. Consideration of underlying spinal pathologies, particularly mass lesions, is critical to the management of intrathecal drug delivery devices.
导管相关炎性肿块（CIMs）是鞘内给药装置一种罕见但严重的并发症。CIM的形成受局部药物浓度影响，而局部药物浓度部分由导管尖端的流体动力学决定。潜在的脊柱病变，如肿瘤，可能改变导管尖端的血流，从而促使CIM形成。此外，它们还可能使CIM的临床和影像学诊断复杂化。
一名患有1型神经纤维瘤病的36岁男性因背痛加剧和腿部无力到我院急诊科就诊。为治疗其多个脊柱肿块继发的疼痛，他此前接受了植入式药物输送系统的植入，该系统输注芬太尼和布比卡因的复合药物。影像学检查显示有许多与神经纤维瘤病相符的肿块，包括一个环绕多孔导管末端且靠近导管尖端的压迫性肿块。对该肿块进行了手术切除；病理结果与导管尖端肉芽肿相符。
在所描述的病例中，CIM的形成可能是由于1）芬太尼浓度异常高，以及2）脊柱神经纤维瘤导致的输注液流动改变共同作用的结果。考虑潜在的脊柱病变，尤其是肿块病变，对于鞘内给药装置的管理至关重要。
