Assessing Syndromes of Catheter Malfunction With SynchroMed Infusion Systems: The Value of Spiral Computed Tomography With Contrast Injection

PM R 2(8):10 (2010) PMID 20709303

Medtronic SynchroMed(R) pump systems have been implanted in more than 100,000 patients to infuse medication into cerebrospinal fluid (CSF). The primary medications delivered are Baclofen and analgesics (i.e. morphine, Dilaudid, bupivicaine, ziconotide). Patients receiving intrathecal medications are very sensitive to changes in the infusion and may have a number of unique clinical presentations related to loss of drug delivery. Malfunctions of the infusion system are typically due to catheter problems. The clinical presentations of seven syndromes of catheter malfunction in patients receiving intrathecal medication will be described: microleak syndrome, delayed leak syndrome, catheter tip loculation, subdural catheter syndrome, catheter migration syndrome, ventriculoperitonal (VP) shunt malfunction syndrome, and catheter tip inflammatory mass. The syndrome, diagnosis, and treatment strategies for each will be discussed. The use of Spiral CT after injection will be described as well as the sensitivity the test has demonstrated in our clinical practice.