title: Management of intrathecal catheter-tip inflammatory masses: a consensus statement.
abstract: OBJECTIVE
  In a companion article, we synthesized current clinical and preclinical data to formulate hypotheses about the etiology of drug administration catheter-tip inflammatory masses. In this article, we communicate our recommendations for the detection, treatment, mitigation, and prevention of such masses.
  
  
  METHODS
  We reviewed published and unpublished case reports and our own experiences to find methods to diagnose and treat catheter-tip inflammatory masses in a manner that minimized adverse neurological sequelae. We also formulated hypotheses about theoretical ways to mitigate, and possibly, prevent the formation of such masses.
  
  
  RESULTS
  Human cases have occurred only in patients with chronic pain who received intrathecal opioid drugs, alone or mixed with other drugs, or in patients who received agents that were not labeled for long-term intrathecal use. Most patients had noncancer pain owing to their large representation among the population with implanted pumps. Such patients also had a longer life expectancy and exposure to intrathecal drugs, and they received higher daily doses than patients with cancer pain. Clues to diagnosis included the loss of analgesic drug effects accompanied by new, gradually progressive neurological symptoms and signs. When a mass was diagnosed before it filled the spinal canal or before it caused severe neurological symptoms, open surgery to remove the mass often was not required. Anecdotal reports and the authors' experiences suggest that cessation of drug administration through the affected catheter was followed by shrinkage or disappearance of the mass over a period of 2-5 months.
  
  
  CONCLUSIONS
  Attentive follow-up and maintenance of an index of suspicion should permit timely diagnosis, minimally invasive treatment, and avoidance of neurological injury from catheter-tip inflammatory masses. Whenever it is feasible, positioning the catheter in the lumbar thecal sac and/or keeping the daily intrathecal opioid dose as low as possible for as long possible may mitigate the seriousness, and perhaps, reduce the incidence of such inflammatory masses.
authors.affiliation: Department of Neurological Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. samuel@neosoft.com
authors.forename: Samuel
authors.initials: S
authors.lastname: Hassenbusch
authors.forename: Kim
authors.initials: K
authors.lastname: Burchiel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Coffey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cousins
authors.forename: Tim
authors.initials: T
authors.lastname: Deer
authors.forename: Marc B
authors.initials: MB
authors.lastname: Hahn
authors.forename: Stuart Du
authors.initials: SD
authors.lastname: Pen
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Follett
authors.forename: Elliot
authors.initials: E
authors.lastname: Krames
authors.forename: James N
authors.initials: JN
authors.lastname: Rogers
authors.forename: Oren
authors.initials: O
authors.lastname: Sagher
authors.forename: Peter S
authors.initials: PS
authors.lastname: Staats
authors.forename: Mark
authors.initials: M
authors.lastname: Wallace
authors.forename: Kenneth Dean
authors.initials: KD
authors.lastname: Willis