{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:59:31Z","timestamp":1769727571299,"version":"3.49.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Intrathecal baclofen pump (ITBP) therapy has been successfully used to treat hypertonia in children with cerebral palsy (CP) since its Food and Drug Administration approval in 1984. CP affects multiple organ systems, leading to the accumulation of medical access and implantable devices, increasing the medical complexity of these children. The authors present the case of a patient with extreme surgical complexity and review the medical decision-making and surgical details.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 16-year-old male with a history of quadriplegic mixed hypertonia secondary to CP presented for ITBP replacement in the setting of pump end of service (EOS). The patient had short bowel syndrome (SBS) and severe scoliosis with a nonhealing costopelvic wound adjacent to the EOS pump. Intrathecal baclofen wean failed due to limited bioavailability from the SBS. The authors performed catheter placement to the skull base via a right C1\u20132 puncture and pectoral pump pocket creation. Treatment was well tolerated, with no procedural complications.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Surgical complexity prompts creative problem-solving. It is critical to consider the nuances of each patient\u2019s history and body habitus to promote ITBP longevity. The authors present the case of a patient with CP who underwent catheter access via C1\u20132 puncture and pectoral pocket creation. In this case, surgery was effective, with an uncomplicated postoperative course. Surgeons should not hesitate to consider alternative implantation strategies in similar circumstances.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24427<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24427","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T01:51:44Z","timestamp":1733104304000},"source":"Crossref","is-referenced-by-count":1,"title":["Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1\u20132 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Shreya","family":"Mukherjee","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"},{"name":"Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunny","family":"Abdelmageed","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"},{"name":"Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam N.","family":"Shahin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey S.","family":"Raskin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"},{"name":"Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Pediatr Clin North Am","first-page":"483","article-title":"Spasticity interventions: decision-making and management","volume":"70","author":"Brandenburg","year":"2023","unstructured":"Brandenburg JERabatin AEDriscoll SW. Spasticity interventions: decision-making and management. Pediatr Clin North Am. 2023;70(3):483-500."},{"key":"bib2","series-title":"Handb Clin Neurol","first-page":"497","article-title":"Treatment of spasticity","volume":"196","author":"Marsden","year":"2023","unstructured":"Marsden JStevenson VJarrett L. Treatment of spasticity. Handb Clin Neurol. 2023;196:497-521."},{"issue":"6","key":"bib3","series-title":"Dev Med Child Neurol","first-page":"721","article-title":"Point prevalence and motor function of children and adolescents with cerebral palsy in Scandinavia and Scotland: a CP-North study","volume":"63","author":"Hollung","year":"2021","unstructured":"Hollung SJH\u00e4gglund GGaston MS, et al. Point prevalence and motor function of children and adolescents with cerebral palsy in Scandinavia and Scotland: a CP-North study. Dev Med Child Neurol. 2021;63(6):721-728."},{"issue":"1","key":"bib4","series-title":"BMC Neurol","first-page":"276","article-title":"Treatment of spasticity in children and adolescents with cerebral palsy in northern Europe: a CP-North registry study","volume":"21","author":"H\u00e4gglund","year":"2021","unstructured":"H\u00e4gglund GHollung SJAhonen M, et al. Treatment of spasticity in children and adolescents with cerebral palsy in northern Europe: a CP-North registry study. BMC Neurol. 2021;21(1):276."},{"issue":"12","key":"bib5","series-title":"Dev Med Child Neurol","first-page":"1249","article-title":"Identification and measurement of dystonia in cerebral palsy","volume":"59","author":"Rice","year":"2017","unstructured":"Rice JSkuza PBaker FRusso RFehlings D. Identification and measurement of dystonia in cerebral palsy. Dev Med Child Neurol. 2017;59(12):1249-1255."},{"issue":"4","key":"bib6","series-title":"J Neurosurg Pediatr","first-page":"389","article-title":"Placement of baclofen pump catheter through a C1\u20132 puncture: technical note","volume":"21","author":"Aljuboori","year":"2018","unstructured":"Aljuboori ZArcher JHuff WMoreno AJea A. Placement of baclofen pump catheter through a C1\u20132 puncture: technical note. 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Clin Pharmacokinet. 2004;43(14):951-962."},{"issue":"3","key":"bib27","series-title":"J Pharmacol Exp Ther","first-page":"911","article-title":"Arbaclofen placarbil, a novel R-baclofen prodrug: improved absorption, distribution, metabolism, and elimination properties compared with R-baclofen","volume":"330","author":"Lal","year":"2009","unstructured":"Lal RSukbuntherng JTai EHL, et al. Arbaclofen placarbil, a novel R-baclofen prodrug: improved absorption, distribution, metabolism, and elimination properties compared with R-baclofen. J Pharmacol Exp Ther. 2009;330(3):911-921."},{"key":"bib28","series-title":"Front Psychiatry","first-page":"485","article-title":"Pharmacokinetic studies of baclofen are not sufficient to establish an optimized dosage for management of alcohol disorder","volume":"9","author":"Simon","year":"2018","unstructured":"Simon NFranchitto NRolland B. Pharmacokinetic studies of baclofen are not sufficient to establish an optimized dosage for management of alcohol disorder. Front Psychiatry. 2018;9:485."},{"issue":"4","key":"bib29","series-title":"J Spinal Cord Med","first-page":"394","article-title":"Effect of intrathecal baclofen concentration on spasticity control: case series","volume":"31","author":"Saval","year":"2008","unstructured":"Saval AChiodo AE. Effect of intrathecal baclofen concentration on spasticity control: case series. J Spinal Cord Med. 2008;31(4):394-397."},{"issue":"11","key":"bib30","series-title":"Acta Paediatr","first-page":"1661","article-title":"Continuous intrathecal baclofen therapy in children with cerebral palsy\u2014when does improvement emerge?","volume":"99","author":"Ramstad","year":"2010","unstructured":"Ramstad KJahnsen RLofterod BSkjeldal OH. Continuous intrathecal baclofen therapy in children with cerebral palsy\u2014when does improvement emerge? 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