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Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations.
J Neurosurg Pediatr. 2012 Oct; 10(4):315-9.JN

Abstract

OBJECT

The aim of this study was to identify the benefits of intraventricular baclofen (IVB) therapy for the treatment of intractable spasticity or dystonia in a subset of patients who had experienced multiple revisions while receiving intrathecal baclofen (ITB) therapy.

METHODS

The authors reviewed the charts of 22 consecutive patients with intractable spasticity or dystonia who initially underwent ITB therapy, subsequently suffered multiple revisions during ITB therapy, and ultimately received IVB therapy, all during a 12-year period from November 1998 to October 2010. The intraventricular catheters were positioned in the lateral ventricle, aided by stereonavigation.

RESULTS

The surgical revision rate (the average number of surgical revisions per average number of follow-up years) during ITB therapy was 0.84, and was 0.50 during IVB therapy. The most frequent complication requiring surgical revision during ITB therapy was catheter occlusion, followed by pump malfunction/pump pocket issues, and infection. The most frequent complication requiring surgical revision during IVB therapy was infection, followed by catheter misplacement/migration. Four patients suffered infection that required removal of their intraventricular catheter, and currently have no baclofen system.

CONCLUSIONS

Some of these patients had a history of increasing revisions with increasing frequency during ITB therapy. Such a history puts them at risk for spinal arachnoiditis, a condition that complicates further ITB therapy. For such patients, the authors believe that IVB therapy may be a beneficial therapeutic option, given that the surgical revision rate was lower for IVB than for ITB. Intraventricular baclofen may be a cost-effective option for patients with mounting revisions during ITB therapy.

Authors+Show Affiliations

Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana 46202, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22861196

Citation

Turner, Michael, et al. "Intraventricular Baclofen as an Alternative to Intrathecal Baclofen for Intractable Spasticity or Dystonia: Outcomes and Technical Considerations." Journal of Neurosurgery. Pediatrics, vol. 10, no. 4, 2012, pp. 315-9.
Turner M, Nguyen HS, Cohen-Gadol AA. Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations. J Neurosurg Pediatr. 2012;10(4):315-9.
Turner, M., Nguyen, H. S., & Cohen-Gadol, A. A. (2012). Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations. Journal of Neurosurgery. Pediatrics, 10(4), 315-9. https://doi.org/10.3171/2012.6.PEDS11456
Turner M, Nguyen HS, Cohen-Gadol AA. Intraventricular Baclofen as an Alternative to Intrathecal Baclofen for Intractable Spasticity or Dystonia: Outcomes and Technical Considerations. J Neurosurg Pediatr. 2012;10(4):315-9. PubMed PMID: 22861196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations. AU - Turner,Michael, AU - Nguyen,Ha Son, AU - Cohen-Gadol,Aaron A, Y1 - 2012/08/03/ PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/12/12/medline SP - 315 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 10 IS - 4 N2 - OBJECT: The aim of this study was to identify the benefits of intraventricular baclofen (IVB) therapy for the treatment of intractable spasticity or dystonia in a subset of patients who had experienced multiple revisions while receiving intrathecal baclofen (ITB) therapy. METHODS: The authors reviewed the charts of 22 consecutive patients with intractable spasticity or dystonia who initially underwent ITB therapy, subsequently suffered multiple revisions during ITB therapy, and ultimately received IVB therapy, all during a 12-year period from November 1998 to October 2010. The intraventricular catheters were positioned in the lateral ventricle, aided by stereonavigation. RESULTS: The surgical revision rate (the average number of surgical revisions per average number of follow-up years) during ITB therapy was 0.84, and was 0.50 during IVB therapy. The most frequent complication requiring surgical revision during ITB therapy was catheter occlusion, followed by pump malfunction/pump pocket issues, and infection. The most frequent complication requiring surgical revision during IVB therapy was infection, followed by catheter misplacement/migration. Four patients suffered infection that required removal of their intraventricular catheter, and currently have no baclofen system. CONCLUSIONS: Some of these patients had a history of increasing revisions with increasing frequency during ITB therapy. Such a history puts them at risk for spinal arachnoiditis, a condition that complicates further ITB therapy. For such patients, the authors believe that IVB therapy may be a beneficial therapeutic option, given that the surgical revision rate was lower for IVB than for ITB. Intraventricular baclofen may be a cost-effective option for patients with mounting revisions during ITB therapy. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/22861196/Intraventricular_baclofen_as_an_alternative_to_intrathecal_baclofen_for_intractable_spasticity_or_dystonia:_outcomes_and_technical_considerations_ L2 - https://thejns.org/doi/10.3171/2012.6.PEDS11456 DB - PRIME DP - Unbound Medicine ER -