Intraventricular Application of Baclofen Using Navigated Frameless Stereotaxy: A Technical Note

The spinal application of intrathecal baclofen (ITB) has been commonly used as treatment for severe dystonia as well spasticity. However, in rare cases, the use of ITB is not possible or ineffective. Therefore, intraventricular application of baclofen (IVB) mostly using endoscopic navigation has been rarely performed over the last years. As a valid alternative, we introduced navigated frameless stereotaxy for intraventricular catheter placement as the most minimally invasive approach feasible.We retrospectively report on surgical technique, clinical outcome, and long-term complications in all pediatric patients with severe generalized dystonia who received IVB using navigated frameless stereotaxy between April 2009 and June 2021 at our institution.Twenty patients (median age: 13 years; range: 2-23 years) were treated with IVB. Dystonia improved in 19/20 patients at the time of discharge (median 51 days; range 2-93 weeks). During the follow-up period (median: 19 months; range: 3-83 months), there was a total of five surgery-associated complications including 3/20 pump infections and 2/20 intraventricular catheter dislocations.This study reveals that navigated frameless catheter positioning in IVB therapy of generalized dystonia is a comparatively low risk and effective surgical procedure.