Epidural granuloma may develop as a complication during long-term use of intrathecal analgesics. To the best of our knowledge, it is not mentioned in the current literature that discontinuation of therapy may cause a regression of epidural granulation and clinical symptoms. In this case, we aimed to present spontaneous regression of epidural granuloma within 2 monthsafter removal of epidural port
Analjeziklerin uzun süreli intratekal uygulamalarında bir komplikasyon olarak epidural granülom gelişebilmektedir. Literatürde tedavinin ara verilmesi ile semptomların gerilediği ve gelişen granülasyon dokusunun iyileşebildiğine dair bir bilgiye rastlanmamıştır. Bu yazı ile epidural portu çekildikten iki ay sonra semptomları gerileyen ve epidural granulomun kendiliğinden iyileşme gösterdiği saptanan olgunun sunulması amaçlanmıştır.
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1. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 1979;50(2):149–51.
2. Aprili D, Bandschapp O, Rochlitz C, Urwyler A, Ruppen W. Serious complications associated with external intrathecal catheters used in cancer pain patients: A systematic review and meta-analysis. Anesthesiology 2009;111(6):1346–55.
3. Deer TR, Prager J, Levy R, Rathmell J, Buchser E, Burton A, et al. Polyanalgesic consensus conference--2012: Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). Neuromodulation 2012;15(5):483–95.
4. North RB, Cutchis PN, Epstein JA, Long DM. Spinal cord compression complicating subarachnoid infusion of morphine: Case report and laboratory experience. Neurosurgery 1991;29(5):778–84.
5. Williams BS, Wong D, Amin S. Case scenario: Self-extraction of intrathecal pump medication with a concomitant intrathecal granulomatous mass. Anesthesiology 2011;114(2):424–30.
6. Pancucci G, Lopez-Gonzalez A, Sanchez-Garví E, RamosSoler D, Pla-Cortina C, Prat-Acin R, et al. Spinal granulomas associated with intradural morphine delivery systems: Early diagnosis and surgical treatment. Clin Neurol Neurosurg 2013;115(10):2270–3.
7. Leong SK, Laing B, Saines N. Magnetic resonance imaging (MR) and computed tomography (CT) findings in intrathecal catheter granuloma: Report of two cases. Eur J Radiol Extra 2010;74(2):e17–21.
8. Yaksh TL, Steinauer JJ, Veesart SL, Malkmus SA. Alfentanil: Correlations between absence of effect upon subcutaneous mast cells and absence of granuloma formation after intrathecal infusion in the dog. Neuromodulation 2013;16(5):459–66.
9. Miele VJ, Price KO, Bloomfield S, Hogg J, Bailes JE. A review of intrathecal morphine therapy related granulomas. Eur J Pain 2006;10(3):251–61.
10. Yalçın Ö, Özoran Y. İnflamasyon ve onarım. In: Tuzalı S, Güllüoğlu M, Çevikbaş U, editors. Robbins Temel Patoloji. 9th ed. İstanbul: Nobel Tıp Kitapevi; 2014.
11. Koeck K, Grossauer S, Trummer M, Kleinert R. Epidural granuloma by dislocated catheter tip associated with spinal cord compression in high-dose intrathecal morphine therapy. Gen Med (Los Angel) 2013;1:1000117.
12. Rodan BA, Cohen FL, Bean WJ, Martyak SN. Fibrous mass complicating epidural morphine infusion. Neurosurgery 1985;16(1):68-70.
13. Philips JA, Escott EJ, Moossy JJ, Kellermier HC. Imaging Appearance of Intrathecal Catheter Tip Granulomas: Report of three cases and review of the literature. AJR 2007; 189:W375–81.
14. Allen JW, Horais KA, Tozier NA, Wegner K, Corbeil JA, Mattrey RF, et al. Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs: A combined magnetic resonance imaging and histopathology investigation. Anesthesiology 2006;105(3):581–9.
15. Coffey RJ, Burchiel K. Inflammatory mass lesions associated with intrathecal drug infusion catheters: Report and observations on 41 patients. Neurosurgery 2002;50(1):78–86.
16. Ebertz JM, Hermens JM, McMillan JC, Uno H, Hirshman C, Hanifin JM. Functional differences between human cutaneous mast cells and basophils: A comparison of morphine-induced histamine release. Agents Actions 1986;18(5-6):455–62.
17. Tharp MD, Kagey-Sobotka A, Fox CC, Marone G, Lichtenstein LM, Sullivan TJ. Functional heterogeneity of human mast cells from different anatomic sites: In vitro responses to morphine sulfate. J Allergy Clin Immunol 1987;79(4):646–53.