Intraventricular Application of Baclofen Using Navigated Frameless Stereotaxy: A Technical Note

Maria Abel; Manfred Kudernatsch; Sergey Persits; Christina Onyinzo; Thomas Herberhold; Till Hartlieb; Gerhard Kluger; Steffen Berweck

doi:10.1055/a-2541-8620

Neuropediatrics, Table of Contents

Neuropediatrics
DOI: 10.1055/a-2541-8620

Original Article

Intraventricular Application of Baclofen Using Navigated Frameless Stereotaxy: A Technical Note

Maria Abel

¹Department of Neurosurgery and Epilepsy Surgery, Spine and Scoliosis Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Manfred Kudernatsch

¹Department of Neurosurgery and Epilepsy Surgery, Spine and Scoliosis Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany

²Research Institute “Rehabilitation, Transition, Palliation,” PMU Salzburg, Salzburg, Austria

,

Sergey Persits

¹Department of Neurosurgery and Epilepsy Surgery, Spine and Scoliosis Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Christina Onyinzo

¹Department of Neurosurgery and Epilepsy Surgery, Spine and Scoliosis Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Thomas Herberhold

³Department of Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Till Hartlieb

²Research Institute “Rehabilitation, Transition, Palliation,” PMU Salzburg, Salzburg, Austria

³Department of Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Gerhard Kluger

²Research Institute “Rehabilitation, Transition, Palliation,” PMU Salzburg, Salzburg, Austria

³Department of Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany

,

Steffen Berweck

³Department of Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany

⁴Dr. von Hauners Children's Hospital, Munich University, Munich, Germany

› Author Affiliations

Abstract

Objective

The spinal application of intrathecal baclofen (ITB) has been commonly used as treatment for severe dystonia as well spasticity. However, in rare cases, the use of ITB is not possible or ineffective. Therefore, intraventricular application of baclofen (IVB) mostly using endoscopic navigation has been rarely performed over the last years. As a valid alternative, we introduced navigated frameless stereotaxy for intraventricular catheter placement as the most minimally invasive approach feasible.

Methods

We retrospectively report on surgical technique, clinical outcome, and long-term complications in all pediatric patients with severe generalized dystonia who received IVB using navigated frameless stereotaxy between April 2009 and June 2021 at our institution.

Results

Twenty patients (median age: 13 years; range: 2–23 years) were treated with IVB. Dystonia improved in 19/20 patients at the time of discharge (median 51 days; range 2–93 weeks). During the follow-up period (median: 19 months; range: 3–83 months), there was a total of five surgery-associated complications including 3/20 pump infections and 2/20 intraventricular catheter dislocations.

Conclusion

This study reveals that navigated frameless catheter positioning in IVB therapy of generalized dystonia is a comparatively low risk and effective surgical procedure.

Keywords

dystonia - intraventricular baclofen - navigated frameless stereotaxy

Full Text

References

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