Cent Eur Neurosurg 2010; 71(1): 39-42
DOI: 10.1055/s-0029-1202359
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Formation of Two Consecutive Intrathecal Catheter Tip Granulomas within Nine Months

P. Hoederath1 , O. P. Gautschi1 , M. Land1 , G. Hildebrandt1 , J.-Y. Fournier1
  • 1Department of Neurosurgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
Further Information

Publication History

Publication Date:
18 November 2009 (online)

Abstract

The formation of catheter tip granulomas is an increasingly observed serious complication of intrathecally administered medication. This complication, which is frequently associated with neurological disturbances, has previously been attributed to high dosages and high concentrations of intrathecal morphine. Much less commonly, intrathecal hydromorphone and intrathecal baclofen have also been associated with intrathecal granuloma formation. In the current case, we report a patient who developed her first catheter tip granuloma after 20 months of intrathecal morphine. After surgical granuloma removal and installation of a new catheter, the patient received intrathecal ziconitide for an interim period of six months. Because of a progressive inefficacy, ziconitide was replaced by hydromorphone. One month later, only nine months after the first operative granuloma removal, a new catheter tip granuloma required a further surgical intervention. This case report highlights the potential of intrathecal morphine and hydromorphone to form consecutive inflammatory granulomas within the same patient. To the best of our knowledge, this is the first report of a patient developing two consecutive catheter tip granulomas within nine months.

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Correspondence

Dr. P. Hoederath

Department of Neurosurgery

Cantonal Hospital of St. Gallen

Rorschacher Straße 95

9007 St. Gallen

Switzerland

Phone: +41/71/494 11 11

Fax: +41/71/494 28 83

Email: petra.hoederath@kssg.ch