This chapter focuses on the surgical technique of implanting intrathecal medication delivery system. Planning for the implantation of an intrathecal medication delivery system requires considerations for the prevention of hardware infection, ergonomics of system function and comfort of the patient, prevention of pump pocket and catheter complications, and prevention of cerebrospinal fluid (CSF) leak. An implanted system for the delivery of intrathecal medication consists of an intrathecal segment of catheter, a subcutaneous segment of catheter, and an implanted pump. The intrathecal and subcutaneous catheter segments may either be part of the same catheter (1-piece catheter) or separate catheters joined with a connecting pin (2-piece catheter system). The site of implant should be chosen so as to avoid other implanted devices such as ventriculoperitoneal shunts, gastrostomy tubes, and other implantable devices such as a neuropulse generator for spinal cord stimulation. The patient is placed on the operating table in the supine position and after the induction of general endotracheal anesthesia, the pump implant site is then marked on the abdomen. The patient is then turned into the lateral decubitus position with the planned pump implant side up and an axillary roll is placed to relieve traction and pressure on the brachial plexus. Under fluoroscopic guidance, the catheter is threaded through the needle to the desired spinal level. The catheter should pass easily and smoothly without obstruction, resistance, or visualized kinking. Once the catheter is inserted intrathecally to its intended target area of the spinal canal and anchored, an incision is made for pump pocket creation.
|Original language||English (US)|
|Title of host publication||Neuromodulation|
|Number of pages||6|
|State||Published - Dec 1 2009|
ASJC Scopus subject areas
- Clinical Neurology
- Anesthesiology and Pain Medicine