Interaction of ventriculoperitoneal shunt and baclofen pump

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.

A review of the pertinent charts, operative notes, and discharge summaries was performed, along with examination of the pertinent literature.

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.