Shearing of an intrathecal catheter during insertion for cerebrospinal fluid drainage

provided the original work is properly cited. CC Intrathecal catheters has been placed for the management of a wide range of medical and surgical conditions [1]. As the use of intrathecal catheters increases, surgeons and anesthesiologists must be made aware of possible complications related to their placement, including infection, headache, pneumocephalus, cerebrospinal fluid (CSF) leakage, neuroaxial hematoma, intracranial hemorrhage, and catheter fracture [2,3]. Breakage or shearing of a catheter is rare or underreported, with an incidence rate of 0 to 3.3% [2,4]. We present a case of intrathecal catheter shearing and fragmentation during insertion, while turning the catheter clockwise through a Tuohy needle for lumbar CSF drainage, and the subsequent surgical removal of the fragment. A 74-year-old man, 160 cm tall and weighing 65 kg, underwent a decompressive craniectomy due to malignant brain edema caused by left middle cerebral artery area infarction. He had right hemiplegia and atrial fibrillation. Two months later, cranioplasty was done for a skull defect, and the surgery was uneventful. Three days later, CSF leakage was observed on brain computed tomography. To promote dural healing, closed continuous lumbar drainage of the CSF was indicated. It was difficult to assume an optimal position for lumbar puncture because of the patient’s hemiplegia. The patient was placed in the left lateral decubitus position with flexion of the left hip and knee. A 14 G Tuohy needle was inserted into the L3-4 intervertebral space without difficulty, obtaining freeflowing CSF. As there was some resistance encountered during advancement of the catheter 8 cm beyond the tip of the needle