Intrathecal Baclofen Therapy in Patients with Ventriculoperitoneal Shunt : A Report of 3 Cases

Abstract

Intrathecal baclofen therapy (ITB) has become the one of the standard treatments for severe spasticity. A preexisting ventricle peritoneal shunt in those patients is not a contraindication for ITB, but we should be aware of complications related to these two devices. The authors performed ITB in three patients who had ventriculoperitoneal shunts previously inserted. The first case is a 41-year-old man, who developed spasticity and dystonia after whole brain and whole spine radiotherapy for a pineal tumor, illustrated severe paralytic ileus one month after pump implantation. The second case is a 22-year-old man with spastic paraparesis after severe brain injury who did not have any complications. The third case is a 14-year-old boy with a history of a cerebral hemorrhage associated with acute leukemia who developed subcutaneous cerebrospinal fluid collection around the catheter tract and pump two months after implantation, which was due to shunt dysfunction. Both complicated cases were treated successfully by reducing the dose of baclofen or changing the pressure setting of the shunt. Patients with ventriculoperitoneal shunts can be successfully treated by ITB, although there is minor additional risk of complications related to cerebrospinal fluid flow dynamics.