Presented at the 2012 AAPM Annual Meeting « Back

Intraoperative Computed Tomography (CT) Confirmation of Placement of an Intrathecal Baclofen Pump Catheter

Tambrea T. Ellison, MD, telliso2@jhmi.edu¹, Nathan J. Neufeld, DO², Richard D. Zorowitz, Doctorate of Medicine³, (1) Johns Hopkins Hospital, Baltimore, Maryland, (2) Johns Hopkins University, Baltimore, Maryland, (3) The Johns Hopkins University School of Medicine, Baltimore, Maryland

Case Diagnosis: A 56-year-old female with persistent spasticity after revision of intrathecal baclofen (ITB) pump. Case Description: The patient suffered a left temporal intracerebral hemorrhage with subsequent right spastic hemiplegia, upper extremity worse than lower. She underwent an initial ITB pump implant with catheter placement at T10. Unfortunately, spasticity of the right upper extremity persisted. It was decided that the ITB pump catheter should be moved to a higher level. After revision of the ITB catheter to T4, the patient was transferred to subacute rehab for medical management and baclofen pump titration. Despite titration of ITB, spasticity in the right upper extremity still persisted. Imaging studies, including radiograph, CT, and MRI demonstrated that the catheter tip appeared adherent to the dorsal membranes, probably in the subdural space. During the second revision of the catheter, intraoperative CT (iCT) imaging of the patient’s spine prior to closure clearly demonstrated that the ITB catheter entered through the laminectomy at T7 and terminated at T4 intrathecally as anticipated. Discussion: Only two hospitals in the United States currently have capabilities of intraoperative CT. The technique of using iCT for intraoperative confirmation of ITB catheter placement has not been reported in the literature. Ultimately, the use of this technique can demonstrate improper placement of an ITB pump catheter, thereby allowing immediate revision of the catheter and preventing unnecessary returns to the operating suite. Conclusion: This case demonstrates confirmation of IT pump catheter placement with iCT. Although this technique is not used in the case of standardized care, it would be useful at limiting preventable revisions.

Funding: None