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Catheter-tip mass mimicking a spinal epidural hematoma
Ricky Medel1, Nader Pouratian, W Jeffrey Elias
1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Journal of Neurosurgery. Spine
|January 2, 2010
Summary
A rare complication of spinal drug-delivery devices, drug precipitation at the catheter tip, can cause serious neurological deficits. Early diagnosis and intervention are crucial for patient recovery and preventing long-term harm.
Area of Science:
- Neurosurgery
- Pain Management
- Pharmacology
Background:
- Over 95,000 spinal drug-delivery devices have been implanted since the 1980s.
- Catheter-tip granulomas are a known complication, but drug precipitation is less common.
- Intrathecal infusions are used for chronic pain management.
Observation:
- A 34-year-old woman with an intrathecal pain pump experienced progressive neurological deficits.
- Neuroimaging revealed a mass at the C7-T1 level, initially suspected to be a hematoma.
- Surgical decompression exposed a chalky mass around the epidural catheter.
Findings:
- Histopathology confirmed a proteinaceous drug precipitate surrounded by fibrosis and inflammation.
- This case highlights epidural bupivacaine precipitation as a rare complication.
- Catheter-tip masses occur in <3% of patients with intrathecal catheters.
Implications:
- Prompt diagnosis and management of catheter-tip masses are essential to prevent severe neurological sequelae.
- Neurological deficits, worsening pain, and increased medication needs are key presenting features.
- Further research is needed on the use of bupivacaine in long-term spinal infusion systems.
