Brief pump externalization without ITB wean to treat a probable pocket infection.
Baclofen pump
Neurosurgery
Spasticity
Wound care
Journal
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Titre abrégé: Childs Nerv Syst
Pays: Germany
ID NLM: 8503227
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
23
05
2023
accepted:
09
07
2023
medline:
29
11
2023
pubmed:
17
7
2023
entrez:
17
7
2023
Statut:
ppublish
Résumé
BACKGROUND AND IMPORTANCE: Intrathecal baclofen (ITB) pumps are an effective management tool for spasticity and dystonia. In the pediatric population, ITB complications including infection are common, and strategies to minimize their impact are important. Current standard of care for pump infection involves a wean of the ITB therapy followed by explantation of the hardware, which can be a three to 6-month process. CLINICAL PRESENTATION: We present a 20-year-old female who developed an pump pocket infection after revision. The pump was removed from the body but left connected. The pocket was debrided, thoroughly washed, and packed with multiple microbicidal agents. Nine days later, a new pump and proximal catheter was re-implanted without complications or interruption of medication administered intrathecally. One year later, the patient is doing well without any infectious problems. CONCLUSION: To our knowledge, this is the first report of an externalized pump and expedited reimplantation without a break in ITB therapy. Further studies are required in order to best characterize this technique as a potential alternative for infected baclofen pump pockets.
Identifiants
pubmed: 37458770
doi: 10.1007/s00381-023-06075-z
pii: 10.1007/s00381-023-06075-z
doi:
Substances chimiques
Baclofen
H789N3FKE8
Muscle Relaxants, Central
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3643-3645Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Woolf SM, Baum CR (2017) Baclofen pumps: uses and complications. Pediatr Emerg Care 33(4):271–275. https://doi.org/10.1097/PEC.0000000000001090 . PMID: 28353527
doi: 10.1097/PEC.0000000000001090
pubmed: 28353527
Ghosh D, Mainali G, Khera J et al (2013) Complications of intrathecal baclofen pumps in children: experience from a tertiary care center. Pediatr Neurosurg 49:138–144
doi: 10.1159/000358307
pubmed: 24577095
Fjelstad A, Hommelstad J, Sorteberg A (2009) Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors. J Neurosurg Pediatr 4:487–493
doi: 10.3171/2009.6.PEDS0921
pubmed: 19877786
Dickey MP, Rice M, Kinnett DG et al (2013) Infectious complications of intrathecal baclofen pump devices in a pediatric population. Pediatr Infect Dis J 32:715–722
doi: 10.1097/INF.0b013e318287f02a
pubmed: 23429557
Nuru M, Maglinger B, Vessell M, Simon JE, Daniels MW, Anderson D, Mutchnick I (2022) Infectious complications and operative management of intrathecal baclofen pumps in the pediatric population: a systematic review and meta-analysis of 20 years of pooled experience. World Neurosurg 163. https://doi.org/10.1016/j.wneu.2022.02.078
Hwang RS, Sukul V, Collison C, Prusik J, Pilitsis JG (2019) A novel approach to avoid baclofen withdrawal when faced with infected baclofen pumps. Neuromodulation Technol Neural Interface 22(7):834–838. https://doi.org/10.1111/ner.12873