title: Subfascial implantation of intrathecal baclofen pumps in children: technical note.
abstract: OBJECTIVE
  Indwelling intrathecal drug delivery systems are becoming increasingly important as a method of neuromodulation within the nervous system. In particular, intrathecal baclofen therapy has shown efficacy and safety in the management of spasticity and dystonia in children. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site. The pediatric population poses particular challenges with regard to these complications because appropriate candidates for intrathecal baclofen therapy are often undernourished and thus have a dearth of soft tissue mass to cover a subcutaneously implanted baclofen pump. We report a technique of subfascial implantation that provides greater soft tissue coverage of the pump, thereby reducing the potential for skin breakdown and improving the cosmetic appearance of the implantation site.
  
  
  METHODS
  Eighteen consecutively treated children (average age, 8 yr, 7 mo) with spasticity and/or dystonia underwent subfascial implantation of a baclofen pump. These children's mean weight of 42.9 lb is less than the expected weight for a group of children in this age group, ranging from 4 years, 8 months, to 15 years, 7 months. In all patients, the pump was inserted into a pocket surgically constructed between the rectus abdominus and the external oblique muscles and the respective anterior fascial layers.
  
  
  RESULTS
  At an average follow-up of 13.7 months, no infection or skin breakdown had occurred at the pump surgical site in any of the 18 patients.
  
  
  CONCLUSIONS
  At this early follow-up, the subfascial implantation technique was associated with a reduced rate of local wound and pump infections and provided optimal cosmetic results as compared with that observed in retrospective cases.
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, New York 10016, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Kopell
authors.forename: D
authors.initials: D
authors.lastname: Sala
authors.forename: W K
authors.initials: WK
authors.lastname: Doyle
authors.forename: D S
authors.initials: DS
authors.lastname: Feldman
authors.forename: J H
authors.initials: JH
authors.lastname: Wisoff
authors.forename: H L
authors.initials: HL
authors.lastname: Weiner
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D016343:Monitoring, Intraoperative; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen