Safety and efficacy of the novel subfascial with umbilicus detachment technique for intrathecal baclofen therapy in pediatric patients with cerebral palsy and low body mass index.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Pier Francesco Costici, Rosa Russo, Paolo Brigato, Sergio De Salvatore, Andrea Vescio, Leonardo Oggiano, Fabrizio Donati
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Abstract

Purpose: Intrathecal baclofen (ITB) therapy is a key intervention for managing severe spasticity in pediatric cerebral palsy (CP) patients. However, standard surgical techniques for ITB pump placement pose challenges in low body mass index (BMI) patients, who have limited soft tissue coverage, increasing the risk of complications such as infections and skin erosions. This study compares three techniques-subcutaneous (SC), subfascial (SF), and a novel subfascial with umbilicus detachment (SFUD) approach-specifically aimed at reducing these risks and improving surgical outcomes in this vulnerable population.

Methods: Retrospective cohort study on 54 pediatric CP patients (BMI ≤ 18.5 kg/m2) who underwent initial ITB implantation from January 2004 to July 2018. Patients were divided into SC, SF, and SFUD groups, and outcomes such as surgical time, blood loss, length of hospital stay (LOS), complications, and pump explants were analyzed.

Results: The SFUD group had the highest successful implant rate (93.7%), compared to 79.2% for SF and 57.1% for SC (p < 0.05). SFUD also showed the lowest complication rates, with minimal infections and no skin erosions or pump removals. The SC group experienced the highest complications, including infections and skin erosions. Mean LOS was significantly shorter in the SFUD group.

Conclusion: The SFUD technique provides a safe and effective alternative for ITB pump implantation in CP patients with low BMI, reducing complications and improving implant stability. Further studies are warranted to confirm these findings and support broader clinical adoption.

新型筋膜下带脐脱离技术鞘内巴氯芬治疗小儿脑瘫低体重指数患者的安全性和有效性
目的:鞘内巴氯芬(ITB)治疗是治疗小儿脑瘫(CP)患者严重痉挛的关键干预措施。然而,对于身体质量指数(BMI)较低的患者,标准的ITB泵放置手术技术存在挑战,因为这些患者的软组织覆盖范围有限,增加了感染和皮肤糜烂等并发症的风险。本研究比较了三种技术——皮下(SC)、筋膜下(SF)和一种新的筋膜下带脐脱离(SFUD)入路——专门针对这些易感人群降低这些风险和改善手术结果。方法:回顾性队列研究2004年1月至2018年7月54例首次行颅内炎植入术的小儿CP患者(BMI≤18.5 kg/m2)。将患者分为SC组、SF组和SFUD组,分析手术时间、出血量、住院时间(LOS)、并发症和泵体移植等结果。结果:SFUD组种植成功率最高(93.7%),SF组为79.2%,SC组为57.1%。(p)结论:SFUD技术为低BMI的CP患者ITB泵植入术提供了一种安全有效的选择,减少了并发症,提高了种植体的稳定性。需要进一步的研究来证实这些发现,并支持更广泛的临床应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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