Subfascial implantation of intrathecal baclofen pumps in children: Technical note

Objective: Indwelling intrathecal drug delivery systems are becoming increa singly important as a method of neuromodulation within the nervous system. In particular, intrathecal baclofen therapy has shown efficacy and safety i n the management of spasticity and dystonia. in children. The most common c omplications leading to explantation of the pumps are skin breakdown and in fection at the pump implantation site. The pediatric population poses parti cular challenges with regard to these complications because appropriate can didates for intrathecal baclofen therapy are often undernourished and thus have a dearth of soft tissue mass to cover a subcutaneously implanted baclo fen pump. We report a technique of subfascial implantation that provides gr eater soft tissue coverage of the pump, thereby reducing the potential for skin breakdown and improving the cosmetic appearance of the implantation si te. Methods: Eighteen consecutively treated children (average age, 8 yr, 7 mo) with spasticity and/or dystonia underwent subfascial implantation of a bacl ofen pump. These children's mean weight of 42.9 lb is less than the expecte d weight for a group of children in this age group, ranging from 4 years, 8 months, to 15 years, 7 months. In all patients, the pump was inserted into a pocket surgically constructed between the rectus abdominus and the exter nal oblique muscles and the respective anterior fascial layers. Results: At an average follow-up of 13.7 months, no infection or skin break down had occurred at the pump surgical site in any of the 18 patients. Conclusion: At this early follow-up, the subfascial implantation technique was associated with a reduced rate of local wound and pump infections and p rovided optimal cosmetic results as compared with that observed in retrospe ctive cases.