Management of pericatheter cerebrospinal fluid leak after intrathecal implantation of a drug delivery system.
Persistent cerebrospinal fluid leak is a known complication of intrathecal pump system insertion for drug delivery. Various treatment modalities, such as an epidural blood patch, use of glue, removal of catheter, and surgical closure of dura and subdural blood patch, have been reported previously. This report presents a 35-year-old woman in whom an intrathecal pump system was inserted for cancer pain management with intrathecal morphine. This was complicated by a persistent cerebrospinal fluid leak that was successfully managed by purse-string sutures over the dura around the catheter, without removing the intrathecal implant. The cause of the cerebrospinal fluid leak and different treatment approaches are discussed.
Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
Prem K
PK
Singh
Roopesh
R
Jain
Seema
S
Mishra
Sunil
S
Kumar
Sushma
S
Bhatnagar
Suryanand
S
Deo
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000150:complications; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002408:Catheters, Indwelling / Q000009:adverse effects; D002555:Cerebrospinal Fluid; D004388:Dura Mater / Q000293:injuries; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008159:Lumbar Vertebrae; D008175:Lung Neoplasms / Q000150:complications; D009020:Morphine / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care / Q000379:methods; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine