Tension Pseudomeningocele Associated with Retained Intrathecal Catheter: A Case Report with a Review of Literature

Abstract

Catheter related complications are not uncommon with permanently implanted intrathecal drug delivery systems. Pericatheter leak of cerebrospinal fluid usually responds to conservative treatment. We report a case of tension pseudomeningocele due to retained lumbar intrathecal catheter. It is essential to be aware of this rare complication and we recommend appropriate neurosurgical involvement in the management of pseudomeningocele to avoid potential and catastrophic complications. This case presents one of the rare complications associated with the implantation of IDDS. If a patient with IDDS develops a complete fracture of the catheter at the spinal end, all attempts should be made to define the 2 ends of the catheter and establish the continuity with a titanium connector. If the spinal end of the catheter is retracted deep into the interspinous ligaments and not recoverable, avoid entering the intrethecal space at the same level. If a patient develops pseudomeningocele in the postoperative period of IDDS and conservative methods including autologous epidural blood patch fail, we recommend an MRI of the spine for a detailed study along with prompt neurosurgical consultation. Key words: Intrathecal catherer, retained, broken intrathecal catheter, pericatheter leak, lumbar swelling, psedomeningocele, duroplasty, ventriculoperitoneal shunt

Fractured Lumbar Drain Catheter Retrieval Using an Endoscopic Transforaminal Approach to the Lumbar Spine

“…2 In addition, fragment size, development of a persistent CSF leak or pseudomeningocele, infection risk, and patient's desires all influence the decision to retrieve the catheter. 3,7 Asymptomatic patients can be managed conservatively; however, the literature has highlighted the potential dangers of observation only. Migration of a retained catheter could lead to a arachnoiditis/radiculopathy, abscess or granuloma formation or even subarachnoid hemorrhage.…”