PMC5735434_01
Computed tomography imaging in axial sequence showing the severed catheter entering the intradural space
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F1
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].
CT Myelography in sagittal plane showing leakage of CSF through the drain site
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F2
A CT with myelogram following injection of dye into the intrathecal pump showed CSF leakage and the pseudomeningocele at L3-4 [Figure 2].
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
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F3
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].