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Management of Cerebrospinal Fluid Leak After Intrathecal Baclofen Pump Procedures in Adolescents With Cerebral Palsy:
B Randall Brenn1,2, Joydeep Baidya3, Dinesh K Choudhry1
1Anesthesiology, Shriners Children's-Philadelphia, Philadelphia, USA.
Insights
Cerebrospinal fluid (CSF) leak occurs in 16% of pediatric patients receiving intrathecal baclofen pumps (ITBP). Most cases resolve with conservative care, but epidural blood patches (EBPs) effectively treat persistent leaks and associated headaches.
Area of Science:
- Pediatric Neurosurgery
- Pain Management
- Neurology
Background:
- Intrathecal baclofen pumps (ITBP) are used in children with cerebral palsy (CP).
- Post-dural puncture headache (PDPH) can arise from cerebrospinal fluid (CSF) leaks after ITBP procedures.
- Epidural blood patches (EBPs) are a common intervention for PDPH.
Purpose of the Study:
- To determine the incidence of CSF leak following ITBP placement or replacement in children with CP.
- To review the management strategies for CSF leak and PDPH in this patient population.
Main Methods:
- Retrospective review of 310 surgical cases (141 new placements, 169 replacements) over eight years.
- Data collected from the anesthesia pain service database.
- Analysis of demographic and clinical information related to ITBP procedures and complications.
Main Results:
- Overall CSF leak incidence was 16% (50/310), with 18% (25/141) following new ITBP placement.
- Children with diplegia had a threefold increased risk of CSF leak.
- Conservative management succeeded in 68% (34/50) of CSF leak cases; 32% (16/50) required EBPs, which were 87.5% (14/16) effective on the first attempt.
Conclusions:
- Cerebrospinal fluid leak is a significant complication after ITBP procedures in children with CP.
- Conservative management is often successful, with EBPs providing an effective treatment for refractory cases.
- Diagnosing PDPH in non-verbal pediatric patients presents a clinical challenge.
Study Objective:
Epidural blood patches (EBPs) are frequently performed in children with cerebral palsy (CP) to manage post-dural puncture headache (PDPH) due to cerebrospinal fluid (CSF) leak after intrathecal baclofen pump (ITBP) placement or replacement procedures. The purpose of our study was to review the incidence and management of CSF leak following ITBP placement or replacement procedures in children with CP. The study was a retrospective review of 245 patients representing 310 surgical cases of baclofen pump insertion (n=141) or reinsertion (n=169) conducted at a 125-bed children's hospital with prominent specialty orthopedics surgical cases.
Measurements:
Demographic and clinical information was obtained from the anesthesia pain service database on all new ITBP placement and subsequent replacements over an eight-year period.
Main Results:
The overall incidence of CSF leak in our population was 16% (50 of 310) and 18% (25 of 141) with a new ITBP placement. Children with diplegia were associated with a threefold risk of developing CSF leak. Of patients who developed CSF leak (n=50), 68% (n=34) were successfully treated conservatively, while 32% (n=16) required EBPs. EBPs were successful in 87.5% (14 of 16) of patients at relieving PDPH on the first attempt. Conclusions: CSF leak is a known problem after ITBP placement and replacement. Most patients were successfully treated with conservative management and EBPs were successful in patients failing conservative therapy. Diagnosing PDPH in non-verbal patients can be challenging.
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