gms | German Medical Science

Objective: Leptomeningeal metastasis (LM) represents a rare but devastating manifestation of primary as well as secondary brain tumors. Approximately 2–5 % of patients with solid tumors are affected. Repeatedly it has been reported that metastatic cells within the subarachnoid space may induce malabsorption of cerebrospinal fluid (CSF) resulting in hydrocephalus.

Method: Between 2005 and 2012 we analyzed 33 patients retrospectively with LM diagnosed by MR imaging. The ratio of LM caused by primary brain tumours and other malignancies was approximately 1:7. Histological evidence of atypical cells within the CSF was found in 9 patients (27% of cases). Finally, four patients presented with a significant ventricle enlargement and clinical symptoms of hydrocephalus (12% of cases). The histological diagnoses were one each of anaplastic oligoastrocytoma (AOA), PECA, PNET and malignant B-cell non-Hodgkin-lymphoma (B-NHL).

Results: Two patients were treated with ventriculoperitoneal shunting (VS). Both of them received further adjuvant therapy, intrathecal chemotherapy for the patient with B-NHL and radiation for the patient with PNET respectively. Median survival after VS was about 12 weeks. The remaining two patients were treated with an external ventricular drainage (EVD). As their initial worse condition convalesced insufficiently they were not considered for a further adjuvant therapy. Accordingly, median survival after EVD was about 2 weeks. Despite poor overall prognosis, in all cases we observed temporary improvement of hydrocephalus-related symptoms.

Conclusions: Hydrocephalus represented a remarkable complication of LM. Clinical symptoms regarding an enlargement of the ventricles can be significantly improved by CSF diversion. But, VS should be provided for patients in an adequate general condition with at least a further treatment option of the underlying tumour disease.