Objective: The authors present three cases of children with shunted hydrocephalus and intrathecal delivery of baclofen via an implanted pump. Each case illustrates a potential interaction of these devices.
Materials And Methods: A review of the pertinent charts, operative notes, and discharge summaries was performed, along with examination of the pertinent literature.
Conclusion: The first case illustrates that a change in the pharmacology or effect of intrathecal baclofen may be caused by a failure of a shunt affecting cerebrospinal fluid clearance. The second case illustrates that patients can have ventricular changes with any procedure that accesses the thecal space, even with a functioning shunt. The third case illustrates that ensuring that a patient's shunt is functional before implantation of a baclofen pump is imperative. As the potential pool of patients with both shunted hydrocephalus and need for intrathecal baclofen grows, clinicians should be aware of potential serious interactions.
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http://dx.doi.org/10.1007/s00381-007-0298-5 | DOI Listing |
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Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
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Geobotany Department, Biological Faculty, Lomonosov Moscow State University, 119234 Moscow, Russia.
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Cooperative Studies Program Coordinating Center, VA Boston, Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111, USA.
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Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy.
Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated.
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