case_images: PMC5735434_01
case_images: Computed tomography imaging in axial sequence showing the severed catheter entering the intradural space
case_images: SNI-8-297-g001.jpg
case_images: PMC5735434_01_SNI-8-297-g001.jpg
case_images: F1
case_images: Two intrathecal catheters were noted on CT imaging entering the spinal canal at the L3-4 level and a few millimeters of the proximal tip of the sheared catheter were visualized into the epidural space [Figure 1].
case_images: CT Myelography in sagittal plane showing leakage of CSF through the drain site
case_images: SNI-8-297-g002.jpg
case_images: PMC5735434_01_SNI-8-297-g002.jpg
case_images: F2
case_images: A CT with myelogram following injection of dye into the intrathecal pump showed CSF leakage and the pseudomeningocele at L3-4 [Figure 2].
case_images: Intra-operative images showing (a) the functional catheter (right side) and the tip of the non-functional catheter (left side), (b) forceps being used to pull the severed catheter and (c) purse string suture being made around the remaining functional catheter to ensure a watertight closure and (d) before closure with a suture at the site of the sheared catheter and the purse string suture around the functional catheter
case_images: SNI-8-297-g003.jpg
case_images: PMC5735434_01_SNI-8-297-g003.jpg
case_images: F3
case_images: The second sheared catheter was identified following completion of a L4 laminotomy and CSF was freely leaking from its open end [Figure 3a]. TF-4 silk suture (Ethicon, Somerville, NJ) [Figure 3c]. This particular suture is preferred by the senior author for dural closure through a tubular retractor because the needle has a semicircular shape which minimizes needle movements. Additionally, a purse string suture was placed around the intact catheter to stop the CSF leak around it [Figure 3c and d].