Prepontine baclofen catheter placement: A case report and technical illustration

Background: Intrathecal baclofen (ITB) is used for medically refractory spasticity and dystonia. There are times when intraventricular baclofen (IVB) is used as a last resort for patients who cannot tolerate or cannot receive intrathecal baclofen through a traditional route. We present a patient with a history of cerebral palsy and multiple ITB and IVB revisions who presented with medically refractory spasticity and severe autonomic storming. Other options are needed for patients with persistent autonomic storming, dystonia and spasticity following IVB and spinal intrathecal baclofen treatment. Methods: We propose a technical variation and case illustration of a prepontine catheter placement through an endoscopic third ventriculostomy. Through this approach, a ventricular catheter was used to deliver baclofen into the intrathecal space. Results: Following the procedure, the patient showed improvement in Ashworth score and autonomic storming. Conclusion: This technique could provide an alternative and superior therapeutic option to traditional catheter placement for intrathecal baclofen delivery.