title: Combined C-arm fluoroscopy and C-arm cone beam computed tomography for the evaluation of patients with possible intrathecal baclofen delivery system malfunctions.
abstract: BACKGROUND
  Evaluating intrathecal baclofen (ITB) delivery systems for potential malfunction can be challenging. The catheter systems are prone to myriad complications that are frequently difficult to ascertain by conventional imaging techniques. Newer imaging technologies and their combinations can be used to identify such problems, define surgical indications, and focus operative planning. C-arm fluoroscopy and C-arm cone beam CT performed in one imaging session represents one such combination that has great utility.
  
  
  OBJECTIVE
  We present a case series of ITB catheter evaluations using combined C-arm fluoroscopy (CF) and C-arm cone beam CT (CCBCT).
  
  
  METHODS
  We retrospectively analyzed 7 pediatric patients who underwent ITB catheter systems evaluations by the use of combined CF and CCBCT. Study variables included indications for evaluation, imaging results, interventions, correlation of surgical findings with imaging, and clinical outcome.
  
  
  RESULTS
  Three patients had intact and patent catheter systems. Four patients demonstrated various problems of the catheter systems, including disconnection, microfracture, fracture with segment migration, and subdural migration. Dosage adjustments improved all patients with normal studies. Surgery was guided by the imaging, and all operative patients improved after targeted interventions. Intraoperative findings correlated perfectly with imaging.
  
  
  CONCLUSIONS
  Combined CF and CCBCT proved highly effective in the evaluation of our patients with potential ITB system malfunctions. This technique is advocated for such evaluations because it accurately defines problems with connectivity, integrity, and position of catheter systems. When surgical intervention is required, this information aids in operative planning.
authors.affiliation: The Christ Hospital, Cincinnati, Ohio, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Schapiro
authors.forename: John
authors.initials: J
authors.lastname: Racadio
authors.forename: Douglas
authors.initials: D
authors.lastname: Kinnett
authors.forename: Todd
authors.initials: T
authors.lastname: Maugans
mesh_terms: D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D058786:GABA-B Receptor Agonists / Q000008:administration & dosage; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000295:instrumentation*; D008297:Male; D055815:Young Adult
chemical_list: D058786:GABA-B Receptor Agonists; D001418:Baclofen