Intrathecal baclofen therapy for pediatric neurological disorders: a single center experience

Abstract

Introduction: The use of intrathecal baclofen (ITB) therapy for pediatric spasticity has increased since its approval in 2007. Our center has performed ITB pump implantation since 2018. In this study, we retrospectively reviewed ITB cases and reported the safe implementation of ITB therapy and its complications at our center.

Purpose and Methods: We reviewed the data of 22 patients who underwent this procedure by 2022 including age at surgery, height, weight, BMI, primary disease, presence of gastrostomy, ventriculoperitoneal shunt (VPS), degree of scoliosis, use of a hybrid operating room, induction time, operation time, blood loss, and complications. Additionally, the induction time, operation time, blood loss, and complications were investigated by dividing the patients into two groups, each with 11 cases, based on the chronological order for the first and second halves.

Results: There was one case of catheter-related complications and one case of cerebrospinal fluid leakage. Furthermore, there was one case of difficult puncture. The induction time was significantly shorter in the second half group (86.1 min in first half group vs. 76.2 min in second half group, P＝0.003). Although there was no significant difference in the operative time, the mean operative time was reduced by 21.5 minutes in second half group. No significant differences were observed in blood loss.

Discussion: In second half group, in which hybrid operating rooms were used more frequently, the time required for induction was reduced by discussing and sharing the positional settings with operating room nurses during preoperative evaluation. Furthermore, the fluoroscopy tube angle at the time of the preoperative evaluation puncture was recorded and reproduced, which was thought to have reduced the operating time. Preoperative evaluation of patients with severe scoliosis is important not only to determine the efficacy of ITB, but also to plan pump implantation. Aspiration from the catheter access port and computed tomography myelography are considered useful for the diagnosis of catheter obstruction. In addition, a compromise between catheter placement height and catheter insertion under direct vision may be useful for avoiding complications in patients with severe scoliosis. difficult catheterization and perioperative shunt dysfunction is necessary. In severely emaciated patients, it is necessary to pay attention to spinal fluid leakage and delayed wound healing.