T. Varghese et al. / Advances in Bioscien ce and Biotechnology 4 (2013) 147-152
Copyright © 2013 SciRes.
152
[9] Miele, V.J., Price, K.O., Bloomfield, S., Hogg, J. and Ba i-
les, J.E. (2006) A review of intrathecal morphine therapy
related granulomas. European Journal of Pain, 10, 251-
261. doi:10.1016/j.ejpain.2005.05.002
ponsiveness to therapy or subtle changes in neurologic
function. We believe this case represents the longest in-
terval to diagnosis after initiation of IT infusion therapy,
as well as one of the shortest intervals of recurrence of a
catheter-tip mass. In addition, the filling defect during
the catheter access study was not appreciated, nor was
the granuloma appreciated on the patient’s initial MRI.
This case report is intended to educate practitioners in
recognizing the presentation of a possible catheter-tip
granuloma, both clinically and radiographically, to help
improve recognition and institute treatment in a quick
and effective manner, and to decrease the prevalence of
mistakenly unidentified catheter-tip granulomas.
[10] Andrés, J.D., Palmisani, S., Villanueva Pérez, V.L., An-
sensio, J. and Lopez-Alcaron, M.D. (2010) Can an intra-
thecal, catheter-tip-associated inflammatory mass reoccur?
The Clinical Journal of Pain, 26, 631-364.
doi:10.1097/AJP.0b013e3181e4a541
[11] Hoederath, P., Gautschi, O.P., Land, M., Hildebrandt, G.
and Fournier, J.Y. (2010) Formation of two consecutive
intrathecal catheter tip granulomas within nine months.
Central European Neurosurgery, 71, 39-42.
doi:10.1055/s-0029-1202359
[12] Jourdain, V., Cantin, L., Prud’Homme, M. and Fournier-
Gosselin, M.P. (2009) Intrathecal morphine therapy-re-
lated granuloma: Faster to grow then thought. Neuro-
modulation, 12, 164-168.
doi:10.1111/j.1525-1403.2009.00205.x
4. ACKNOWLEDGEMENTS
The authors would like to gratefully acknowledge Ashley Zimmerman,
PA-C for her editorial assistance in preparation of this manuscript.
OPEN ACCESS
REFERENCES
[13] Cabbell, K.L., Taren, J.A. and Sager, O. (1998) Spinal
cord compression by catheter granulomas in high-dose in-
trathecal morphine therapy: Case report. Neurosurgery,
42, 1176-1181. doi:10.1097/00006123-199805000-00142
[1] Medtronic Internal Communication (2010) UC201003-
915 EN NP9832 C, Medtronic, Inc. [14] Deer, T., Krames, E.S., Hassenbusch, S.J., Burton, A.,
Caraway, D., Dupen, S., Eisenach, J., Erdek, M., Grigsby,
E., Kim, P., Levy, R., McDowell, G., Mekhail, N., Pan-
chal, S., Prager, J., Rauck, R., Saulino, M., Sitzman, T.,
Staats, P., Stanton-Hicks, M., Stearns, L., Willis, K.D.,
Witt, W., Follett, K., Huntoon, M., Liem, L., Rathmell, J.,
Wallace, M., Buchser, E., Cousins, M. and Donck, A.V.
(2007) Polyanalgesic consensus conference 2007: Recom-
mendations for the management of pain by intrathecal (in-
traspinal) drug delivery: Report of an interdisciplinary ex-
pert panel. Neuromodulation, 10, 300-328.
doi:10.1111/j.1525-1403.2007.00128.x
[2] North, R.B., Cutchis, P.N., Epstein, J.A. and Long, D.M.
(1991) Spinal cord compression complicating subarach-
noid infusion of morphine: Case report and laboratory ex-
perience. Neurosurgery, 29, 778-784.
doi:10.1227/00006123-199111000-00025
[3] Phillips, J.A., Escott, E.J., Moosey, J.J. and Kellermier,
H.C. (2007) Imaging appearance of intrathecal catheter
tip granulomas: Report of three cases and review of the
literature. Ame rican J ournal of Roentge nol ogy, 189, W375-
W381. doi:10.2214/AJR.07.2225
[15] Medel, R., Pouratian, N. and Elias, W.J. (2010) Catheter-
tip mass mimicking a spinal epidural hematoma. Neuro-
surgery, 12, 66-71.
[4] Ramsey, C.N., Owen, R.D., Witt, W.O. and Grider, J.S.
(2008) Intrathecal granuloma in a patient receiving high
dose hydromorphone. Pain Physician, 11, 369-373.
[16] Deer, T.R. (2004) A prospective analysis of intrathecal
granuloma in chronic pain patients: A review of the lite-
rature and report of a surveillance study. Pain Physician,
7, 225-228.
[5] Coffey, R.J. and Burchiel, K.B. (2002) Inflammat ory ma ss
lesions associated with intrathecal drug infusion catheters:
Report and observations on 41 patients. Neurosurgery, 50,
78-86.
[17] Hassenbusch, S., Burchiel, K., Coffey, R.J., Cousins, M.J.,
Deer, T., Hahn, M., Du Pen, S., Follett, K.A., Krames, E.,
Rogers, J.N., Sagher, O., Staats, P.S., Wallace, M. and
Willis, K.D. (2002) Management of intrathecal catheter-
tip inflammatory masses: A consensus statement. Pain
Medicine, 3, 313-323.
doi:10.1046/j.1526-4637.2002.02055.x
[6] Rodan, B.A., Cohen, F.L., Bean, W.J. and Martyak, S.N.
(1985) Fibrous mass complicating epidural morphine in-
fusion. Neurosurgery, 16, 68-70.
doi:10.1227/00006123-198501000-00014
[7] Yaksh, T.L., Hassenbusch, S., Burchiel, K., Hildebrand,
K.R., Page, L.M. and Coffey, R.J. (2002) Inflammatory
masses associated with intrathecal drug infusion: A re-
view of preclinical evidence and human data. Pain Medi-
cine, 3, 300-312. doi:10.1046/j.1526-4637.2002.02048.x [18] Blount, J.P., Remley, K.B., Yue, S.K. and Erickson, D.L.
(1986) Intrathecal granuloma complicating chronic spinal
infusion of morphine. Journal of Neurosurgery, 84, 272-
276. doi:10.3171/jns.1996.84.2.0272
[8] Follett, K.A. (2003) Intrathecal analgesia and catheter-tip
inflammatory masse s. Anesthesiology, 99, 5-6.
doi:10.1097/00000542-200307000-00004