Hagemann Christian, Schmitt Ilka, Lischetzki Grischa, Kunkel Philip
Department of Pediatric Neurosurgery, Altona Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.
Department of Pediatric Neurology, Altona Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.
Childs Nerv Syst. 2020 Apr;36(4):767-773. doi: 10.1007/s00381-019-04341-7. Epub 2019 Aug 9.
The aim of this study is to prove the efficacy and safety of intrathecal baclofen therapy in infants and children below 6 years of age by retrospective analysis of our pediatric cohort of 135 primary pump implantations.
Between 2007 and 2018, 17 patients with pump implantations were below 6 years of age. Data were acquired retrospectively with a follow-up of 12 months to 11 years regarding complications.
The youngest infant was 11 months at implantation with a bodyweight of 6, 4 kg, and 63 cm length. Surgical complications were comparable to published literature and mainly involved the catheter (2 catheter dislocations and 1 catheter transection) and one pump infection resulting in 4 revision surgeries in 3 patients. One baclofen-related apnea during titration and an overdose after refill were treated conservatively. Using a subfascial implantation technique, we observed neither skin ulceration nor pump infection since 2007. In a growing child, catheter slides are common and related to growth, scoliosis, spine surgery, and surgical failure.
Intrathecal baclofen therapy in infants and small children is as safe and effective as published for older pediatric patients; therefore, intrathecal baclofen can be considered in all infants as long as an 8-cm incision fits into the triangle of the anterior superior iliac spine, costal margin of the 10th rib, and navel. We suggest the utilization of subfascial surgical technique for implantation pump and catheter. Titration of intrathecal baclofen should be performed slowly to avoid bradycardia in infants. This is a retrospective study (level of evidence 4).
本研究旨在通过对135例初次泵植入的儿科队列进行回顾性分析，证明鞘内注射巴氯芬疗法在6岁以下婴幼儿中的有效性和安全性。
2007年至2018年期间，17例接受泵植入的患者年龄在6岁以下。回顾性收集数据，随访12个月至11年，了解并发症情况。
最年幼的婴儿在植入时为11个月大，体重6.4千克，身长63厘米。手术并发症与已发表文献相当，主要涉及导管（2例导管脱位和1例导管横断）以及1例泵感染，导致3例患者进行了4次翻修手术。滴定过程中发生1例与巴氯芬相关的呼吸暂停， refill后发生1例过量，均采用保守治疗。自2007年以来，采用筋膜下植入技术，我们未观察到皮肤溃疡或泵感染。在生长中的儿童中，导管滑动很常见，与生长、脊柱侧弯、脊柱手术和手术失败有关。
婴幼儿鞘内注射巴氯芬疗法与 older儿科患者发表的结果一样安全有效；因此，只要8厘米的切口适合于髂前上棘、第10肋肋缘和肚脐所构成的三角区，所有婴幼儿均可考虑鞘内注射巴氯芬。我们建议采用筋膜下手术技术植入泵和导管。鞘内注射巴氯芬的滴定应缓慢进行，以避免婴儿心动过缓。这是一项回顾性研究（证据水平4）。
