title: Interaction of ventriculoperitoneal shunt and baclofen pump.
abstract: OBJECTIVE
  The authors present three cases of children with shunted hydrocephalus and intrathecal delivery of baclofen via an implanted pump. Each case illustrates a potential interaction of these devices.
  
  
  METHODS
  A review of the pertinent charts, operative notes, and discharge summaries was performed, along with examination of the pertinent literature.
  
  
  CONCLUSIONS
  The first case illustrates that a change in the pharmacology or effect of intrathecal baclofen may be caused by a failure of a shunt affecting cerebrospinal fluid clearance. The second case illustrates that patients can have ventricular changes with any procedure that accesses the thecal space, even with a functioning shunt. The third case illustrates that ensuring that a patient's shunt is functional before implantation of a baclofen pump is imperative. As the potential pool of patients with both shunted hydrocephalus and need for intrathecal baclofen grows, clinicians should be aware of potential serious interactions.
authors.affiliation: Pediatric Neurosurgery Service, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Room 1134, Indianapolis, IN 46202, USA. dfulkers@iupui.edu
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Fulkerson
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boaz
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
mesh_terms: D001418:Baclofen / Q000008:administration & dosage* / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics; D001921:Brain / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000150:complications / Q000628:therapy*; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D013116:Spinal Cord / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen