Formation of two consecutive intrathecal catheter tip granulomas within nine months.

P Hoederath, O P Gautschi, M Land, G Hildebrandt, J Y Fournier
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引用次数: 20

Abstract

The formation of catheter tip granulomas is an increasingly observed serious complication of intrathecally administered medication. This complication, which is frequently associated with neurological disturbances, has previously been attributed to high dosages and high concentrations of intrathecal morphine. Much less commonly, intrathecal hydromorphone and intrathecal baclofen have also been associated with intrathecal granuloma formation. In the current case, we report a patient who developed her fi rst catheter tip granuloma after 20 months of intrathecal morphine. After surgical granuloma removal and installation of a new catheter, the patient received intrathecal ziconitide for an interim period of six months. Because of a progressive inefficacy, ziconitide was replaced by hydromorphone. One month later, only nine months after the fi rst operative granuloma removal, a new catheter tip granuloma required a further surgical intervention. This case report highlights the potential of intrathecal morphine and hydromorphone to form consecutive inflammatory granulomas within the same patient. To the best of our knowledge, this is the fi rst report of a patient developing two consecutive catheter tip granulomas within nine months.

9个月内连续2次鞘内导管尖端肉芽肿。
导管尖端肉芽肿的形成是越来越多的观察到的严重并发症鞘内给药。这种并发症通常与神经障碍有关,以前认为是鞘内注射高剂量和高浓度吗啡所致。更不常见的是,鞘内氢吗啡酮和鞘内巴氯芬也与鞘内肉芽肿形成有关。在本病例中,我们报告一位患者在鞘内注射吗啡20个月后出现了她的第一个导管尖端肉芽肿。手术切除肉芽肿并安装新导管后,患者鞘内注射齐iconitide 6个月。由于逐渐无效,改用氢吗啡酮代替齐可尼肽。一个月后,第一次手术肉芽肿切除后仅9个月,新的导管尖端肉芽肿需要进一步的手术干预。本病例报告强调鞘内吗啡和氢吗啡酮在同一患者体内形成连续炎性肉芽肿的可能性。据我们所知,这是首例患者在9个月内连续发生两次导管尖端肉芽肿的报告。
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
Central European Neurosurgery
Central European Neurosurgery CLINICAL NEUROLOGY-NEUROSCIENCES
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