title: Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity.
abstract: The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump's side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Florida.
authors.forename: Amer
authors.initials: A
authors.lastname: Dastgir
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Florida.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Ranalli
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Florida.
authors.forename: Theresa L
authors.initials: TL
authors.lastname: MacGregor
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Florida.
authors.forename: Philipp R
authors.initials: PR
authors.lastname: Aldana
mesh_terms: D000005:Abdomen; D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002547:Cerebral Palsy / Q000150:complications* / Q000209:etiology; D005548:Foreign-Body Migration; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: baclofen pump; baclofen withdrawal; catheter migration; functional neurosurgery; intrathecal; leakage; perforation; spasticity