How can a diagnosis of granuloma be confirmed, and what is the treatment for it?
The primary method to confirm the presence of a granuloma is with imaging, either magnetic resonance imaging (MRI) or computed tomography myelography, focusing on the area around the catheter tip that can reveal a mass or filling defect, respectively, confirming the diagnosis. Treatment of a granuloma will depend upon the clinical symptoms of the patient. For those patients who present with new neurologic deficits attributable to the granuloma, emergent surgical decompression is warranted. If neurologic deficits are not present on exam, the intrathecal catheter can be revised on an urgent basis. The best method to prevent granulomas from forming is to avoid the use of highly concentrated intrathecal analgesics, particularly opioids, beyond recommended limits. Revisions should be performed with a surgeon familiar with granuloma management.