gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Palliative CSF diversion in leptomeningeal metastasis – a feasibility analysis

Palliative VP-Shunt Anlage bei Meningeosis Carcinomatosa: eine Machbarkeitsanalyse

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Obada T. Alhalabi - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Alexander Younsi - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV171

doi: 10.3205/22dgnc166, urn:nbn:de:0183-22dgnc1667

Veröffentlicht: 25. Mai 2022

© 2022 Alhalabi et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objective: Leptomeningeal metastases (LM) represent a dire terminal condition in many patients with primary extra-cranial malignancies. With improved survival rates of patients under novel systemic therapy for their respective primary tumors, the role of cerebrospinal fluid (CSF) diversion via ventriculo-peritoneal shunts (VP-shunt) for symptom control of hydrocephalic LM is gaining more relevance. This study aimed to describe this patient cohort and weigh out the benefits against the adverse events after palliative VP-shunt placement.

Methods: A single-center retrospective analysis of all consecutive adult patients with VP-shunt placement over a period of six years was performed and clinical data (primary disease, clinical presentation, CSF diagnostics, previous therapies) in addition to surgical data (shunt devices, surgeries, and complications) and survival data were collected. Results were compared to a “non-oncological” shunt cohort and statistical analysis was performed.

Results: 38 patients with a median age of 53 (18-75) years (13 males, 25 females) underwent VP-Shunt placement. Most common underlying oncological conditions were breast cancer (n=21, 55%) and non-small cell lung cancer (NSCLC, n=11, 29%). The median time between primary tumor and LM diagnosis was 23 months (0 to 180 months). 14 patients (37%) presented with end-stage disease at primary tumor diagnosis, 25 (66%) patients had cranial metastases. Most patients presented with classical symptoms of intracranial hypertension and 11 patients (38%) already received intrathecal treatment or radiotherapy before shunting. After shunting, symptom relief was achieved in 30 patients (79%) and 24 patients (63%) were eventually discharged home after surgery. Subsequently, 63% of the shunted patients underwent systemic or radiotherapy and 55% received intrathecal therapy. Revision surgery was conducted for valve malfunctions and infections (n=3, 8% for either) or distal catheter malposition (n=2, 5%) but comparison with a “non-oncological” shunt cohort showed no differences in complication rates. Median survival from shunting was 2.1 months (95% CI 0.5 to 3 months).

Conclusion: While VP-shunt placement could relief symptoms of intracranial hypertension pertaining to LM of primary solid tumors without a higher rate of shunt complications with many patients discharged home and continuing oncologic therapy, decision-making regarding VP-shunt placement in LM patients retains a palliative nature.