gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Clinical experience with hydrocephalus induced by leptomeningeal metastasis and implications for neurosurgical treatment

Meeting Abstract

  • Claudius Friedel - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald, Germany
  • Sönke Langner - Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Universität Greifswald, Germany
  • Henry W. S. Schroeder - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald, Germany
  • Jörg Baldauf - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald, Germany

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 098

doi: 10.3205/13dgnc515, urn:nbn:de:0183-13dgnc5159

Published: May 21, 2013

© 2013 Friedel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.