title: Management of symptomatic intrathecal catheter-associated inflammatory masses.
abstract: OBJECTIVE
  Intrathecal catheter-associated inflammatory masses (CIMs) are a serious complication of implanted drug pumps. The goal of this study was to review our experience with CIMs, including the pathology of all resected CIMs, and identify objective data which may guide management.
  
  
  METHODS
  We performed a retrospective review of 13 patients who developed symptomatic CIMs during continuous intrathecal opioid therapy for chronic pain. Eight patients presented with pain plus neurologic deficit and 5 patients presented with pain alone.
  
  
  RESULTS
  CIM resection via laminectomy and intradural exploration was ultimately performed in 8 patients, 3 of whom were initially treated with a non-resective surgical approach (catheter repositioning or pump removal) that failed. All 3 patients who experienced a failure with non-resective surgery had CIMs located in the thoracic spine with a maximum diameter≥13 mm and 2 of these patients had neurologic deficits on presentation.
  
  
  CONCLUSIONS
  Our experience, with the largest reported single-surgeon series of patients harboring CIMs, favors early resection, especially in patients with neurologic deficit. Resection may also be a prudent first-line strategy for patients with larger thoracic masses (≥13 mm) regardless of neurologic status. Neurologic deficits engendered by CIM usually improve after resection and the majority of patients in our series would have still elected to have an intrathecal pump for pain control knowing a CIM would have developed.
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA 15213, USA. tomycznd@upmc.edu
authors: Nestor D
authors: ND
authors: Tomycz
authors: Veronica
authors: V
authors: Ortiz
authors: Kathryn A
authors: KA
authors: McFadden
authors: Louisa
authors: L
authors: Urgo
authors: John J
authors: JJ
authors: Moossy
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D057785:Catheters / Q000009:adverse effects*; D005260:Female; D006099:Granuloma / Q000473:pathology / Q000601:surgery; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000627:therapeutic use; D007249:Inflammation / Q000209:etiology* / Q000473:pathology*; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures; D010146:Pain / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013131:Spine / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone