title: Intracranial migration of a fractured intrathecal catheter from a baclofen pump system: case report and analysis of possible causes.
abstract: OBJECTIVE
  This case report describes a new complication associated with a baclofen pump in which its fractured intrathecal catheter migrated into the patient's ventricular system. A thecal model was developed to evaluate catheter buoyancy in artificial cerebrospinal fluid (CSF). The literature was reviewed to identify possible mechanical and physiologic causes of catheter migration.
  
  
  METHODS
  A 16-year-old boy with cerebral palsy presented with cervical pain, nausea, and vomiting. He was known to have a nonfunctioning baclofen pump with a 1-piece intrathecal catheter. Imaging studies showed mild ventriculomegaly and a fractured segment of the intrathecal catheter that extended from the cervical subarachnoid space into the third and fourth ventricles.
  
  
  METHODS
  The patient had complete symptom resolution after undergoing urgent surgical removal of the catheter segment. Manufacturer analysis of the retrieved catheter revealed a crushed, jagged proximal end. In an experimental thecal sac model, catheter segments in lengths of 0.5 to 89 cm were denser than the artificial CSF and, therefore, did not float in the thecal sac. This finding negates the role of buoyancy in migration. Review of the literature advocates for caudocranial CSF flow patterns as a plausible mechanism for migration.
  
  
  CONCLUSIONS
  This complication alerts surgeons to the migration risk of loose intrathecal catheter segments into the ventricular system. CSF flow patterns and mechanical processes, but not material properties of the catheter, are likely causes.
authors.affiliation: Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA. editor@mayfieldclinic.com
authors.forename: Todd A
authors.initials: TA
authors.lastname: Maugans
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000188:drug therapy; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen