Intrathecal Granuloma in Patients Receiving High‐dose Intrathecal Morphine Therapy: A Report of Two Cases

Intrathecal narcotic pumps are widely used for malignant and benign pain. 1–8 Short-term effects have been reported including respiratory depression, nausea and vomiting, pruritus, tolerance, urinary retention, altered sexual function, amenorrhea, pump failure, misplaced catheters, myoclonus, peripheral edema, cerebrospinal fluid leak, and meningitis. 1,4,9,10–17,20 Long-term effects of implantation and intrathecal drug exposure are becoming more prevalent. Intrathecal inflammatory tissue masses have previously been reported in the literature. 10,18–20 This report describes the clinical, radiographic, and pathological reports of two cases of intrathecal inflammatory tissue masses. A review of the literature as to the clinical presentation, radiographic evidence, pathological reports, evaluation/treatment strategies, and pathophysiological hypotheses will be presented. CLINICAL PRESENTATION

[1]  L. Andrew.  Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. , 1999 .

[2]  O. Sagher,et al.  Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. , 1998, Neurosurgery.

[3]  G. Bejjani,et al.  Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature. , 1997, Surgical neurology.

[4]  B. Crul,et al.  Neurological impairment during long-term intrathecal infusion of bupivacaine in cancer patients: a sign of spinal cord compression , 1997, Pain.

[5]  W. Winkelmüller,et al.  Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. , 1996, Journal of neurosurgery.

[6]  J. Blount,et al.  Intrathecal granuloma complicating chronic spinal infusion of morphine. Report of three cases. , 1996, Journal of neurosurgery.

[7]  R. Penn,et al.  Amenorrhea associated with intraspinal morphine. , 1995, Journal of Pain and Symptom Management.

[8]  J. Lange,et al.  Intrathecal administration of high-dose morphine solutions decreases the pH of cerebrospinal fluid , 1995, Pain.

[9]  F. Chambers,et al.  Intrathecal morphine in the treatment of chronic intractable pain , 1994, Irish journal of medical science.

[10]  P. J. Hoopes,et al.  Comparative spinal neuropathology of hydromorphone and morphine after 9- and 30-day epidural administration in sheep. , 1994, Anesthesia and analgesia.

[11]  R. Penn,et al.  Altered sexual function and decreased testosterone in patients receiving intraspinal opioids. , 1994, Journal of pain and symptom management.

[12]  J. Deleo,et al.  Testing an Implantable Intraspinal Drug Delivery Device in the Ewe , 1992, Regional Anesthesia & Pain Medicine.

[13]  J. Schramm,et al.  Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain. , 1992, Neurosurgery.

[14]  R. Penn.  Intrathecal baclofen for spasticity of spinal origin: seven years of experience. , 1992, Journal of neurosurgery.

[15]  C. Wu,et al.  Accidental overdose of systemic morphine during intended refill of intrathecal infusion device. , 1992, Anesthesia and analgesia.

[16]  D. Long,et al.  Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. , 1991, Neurosurgery.

[17]  T. Yaksh,et al.  Long-term pain relief produced by intrathecal morphine infusion in 53 patients. , 1990, Journal of neurosurgery.

[18]  R. Snow,et al.  Clinical-pathological analysis of failed central nervous system fluid shunts. , 1989, Journal of biomedical materials research.

[19]  R. Snow,et al.  Hypersensitivity reaction associated with sterile ventriculoperitoneal shunt malfunction. , 1989, Surgical neurology.

[20]  Auld Aw,et al.  Intraspinal narcotic analgesia. Pain management in the failed laminectomy syndrome. , 1987 .

[21]  R. Penn,et al.  Chronic intrathecal morphine for intractable pain. , 1987, Journal of neurosurgery.

[22]  T. Murphy,et al.  Intraspinal narcotics: non‐malignant pain , 1987, Acta anaesthesiologica Scandinavica. Supplementum.

[23]  B. Sugarman,et al.  Infections and prosthetic devices. , 1986, The American journal of medicine.

[24]  A. Auld,et al.  Intraspinal Narcotic Analgesia in the Treatment of Chronic Pain , 1985, Spine.

[25]  D. Nierenberg,et al.  Neuropathologic lesions and CSF morphine concentrations during chronic continuous intraspinal morphine infusion. A clinical and post-mortem study , 1985, Pain.

[26]  D. Gower,et al.  Sterile shunt malfunction. A scanning electron microscopic perspective. , 1984, Journal of neurosurgery.

[27]  R. Harbaugh,et al.  Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir. , 1983, JAMA.

[28]  E. Hazrati.  Continuous low‐dose intrathecal morphine administration in the treatment of chronic pain of malignant origin , 1983 .

[29]  D. Perl,et al.  CONTINUOUS INFUSION OF EPIDURAL ANAESTHESIA AND POSTERIOR COLUMN DEGENERATION , 1982, The Lancet.

[30]  W. Ensminger,et al.  Benefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain. , 1982, Journal of neurosurgery.

[31]  P. Winter,et al.  Acute and Chronic Effects of Intrathecal Morphine in Monkeys , 1981, British journal of anaesthesia.

[32]  T. Yaksh,et al.  Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. , 1981, Mayo Clinic proceedings.

[33]  P. Bromage.  The price of intraspinal narcotic analgesia: basic constraints. , 1981, Anesthesia and analgesia.

[34]  L. S. Reisner,et al.  Persistent neurologic deficit and adhesive arachnoiditis following intrathecal 2-chloroprocaine injection. , 1980, Anesthesia and analgesia.

[35]  T. Ruch,et al.  Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland. , 1980, Journal of neurosurgery.

[36]  E. Everett,et al.  Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species). , 1976, Journal of neurosurgery.

[37]  T. Bedford.  The effect of injected solutions on the cell content of the cerebrospinal fluid. , 1948, British journal of pharmacology and chemotherapy.

[38]  A. Langsam.  Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. , 1999, Neurosurgery.

[39]  A. Auld,et al.  Intraspinal narcotic analgesia. Pain management in the failed laminectomy syndrome. , 1987, Spine.

[40]  D. Perl,et al.  Continuous infusion of epidural anesthesia and posterior column deterioration. , 1982, Lancet.