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Intraventricular Application of Baclofen Using Navigated Frameless Stereotaxy: A Technical Note
Maria Abel1, Manfred Kudernatsch1,2, Sergey Persits1
1Department of Neurosurgery and Epilepsy Surgery, Spine and Scoliosis Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany.
Navigated frameless stereotaxy for intraventricular baclofen (IVB) offers an effective, minimally invasive treatment for severe generalized dystonia when intrathecal baclofen (ITB) is not feasible. This approach demonstrated significant symptom improvement with a low complication rate in pediatric patients.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Technology
Background:
- Intrathecal baclofen (ITB) is a standard treatment for severe dystonia and spasticity.
- ITB is not always effective or feasible for all patients.
- Intraventricular baclofen (IVB) is an alternative but rarely performed, often requiring endoscopic navigation.
Purpose of the Study:
- To introduce and evaluate navigated frameless stereotaxy for intraventricular catheter placement in pediatric patients with severe generalized dystonia.
- To assess the surgical technique, clinical outcomes, and long-term complications of this minimally invasive approach.
Main Methods:
- Retrospective case series of pediatric patients treated with IVB using navigated frameless stereotaxy.
- Data collected on surgical technique, clinical improvement, and complications from April 2009 to June 2021.
- Median patient age was 13 years; follow-up median was 19 months.
Main Results:
- Nineteen out of twenty pediatric patients (95%) experienced dystonia improvement at discharge.
- The procedure was performed using a minimally invasive, navigated frameless stereotactic technique.
- Five surgery-associated complications occurred: 3 pump infections and 2 catheter dislocations.
Conclusions:
- Navigated frameless stereotaxy for IVB catheter placement is a safe and effective surgical procedure for pediatric generalized dystonia.
- This technique provides a viable alternative when ITB is not an option.
- The approach demonstrates a comparatively low risk profile for long-term management.
