Advancements in cancer treatment have led to more cases of leptomeningeal disease, which requires a multimodal approach.
Methods
Treatment modalities are reviewed from a neurosurgical standpoint, focusing on intrathecal chemotherapy and shunting devices. Potential complications and how to avoid them are discussed.
Results
The Ommaya reservoir and the chemoport are used for administering intrathecal chemotherapy. Use of ventriculo-lumbar perfusion can efficiently deliver chemotherapeutic agents and improve intracerebral pressure. Shunting systems, in conjunction with all of their variations, address the challenge of hydrocephalus in leptomeningeal carcinomatosis. Misplaced catheters, malfunction of the system, and shunt-related infections are known complications of treatment.
Conclusions
From an oncological perspective, the surgical treatment for leptomeningeal disease is limited; however, neurosurgery can be used to aid in the administration of chemotherapy and address the issue of hydrocephalus. Minimizing surgical complications is important in this sensitive patient population.
References
1.
MackF., BaumertB.G., SchäferN.Therapy of leptomeningeal metastasis in solid tumors.Cancer Treat Rev.2016; 43: 83–91.
2.
KakM., NandaR., RamsdaleE.E.Treatment of leptomeningeal carcinomatosis: current challenges and future opportunities.J Clin Neurosci.2015; 22(4): 632–637.
3.
GrovesM.D.Leptomeningeal disease.Neurosurg Clin N Am.2011; 22(1): 67–78.
4.
YoshidaS., MoriiK.Intrathecal chemotherapy for patients with meningeal carcinomatosis.Surg Neurol.2005; 63(1): 52–55.
5.
NakagawaH., MurasawaA., KuboS.Diagnosis and treatment of patients with meningeal carcinomatosis.J Neurooncol.1992; 13(1): 81–89.
6.
OmmayaA.K.Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid.Lancet.1963; 2(7315): 983–984.
7.
PackerR.J., ZimmermanR.A., RosenstockJ.Focal encepha-lopathy following methotrexate therapy. Administration via a misplaced intraventricular catheter.Arch Neurol.1981; 38(7): 450–452.
8.
WeinerG.M., ChivukulaS., ChenC.J.Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pin-less electromagnetic surgical neuronavigation.Clin Neurol Neurosurg.2015; 130: 61–66.
9.
GreenfieldJ.P., SchwartzT.H.Catheter placement for Ommaya reservoirs with frameless surgical navigation: technical note.Stereotact Funct Neurosurg.2008; 86(2): 101–105.
10.
StarkA.M., HugoH.H., MehdornH.M.Acute hydrocephalus due to secondary leptomeningeal dissemination of an anaplastic oligodendroglioma.Case Rep Med.2009; 2009: 370901.
11.
MagtibayP.M., FriedmanJ.A., RaoR.D.Unusual presentation of adult metastatic peritoneal medulloblastoma associated with ventriculoperitoneal shunt: a case study and review of the literature.Neuro Oncol.2003; 5(3): 217–220.
12.
OemusK., GerlachH., RathF.W.A rare complication of shunt therapy. Metastasis of brain tumors by cerebrospinal fluid drainage [in German].Zentral-bl Neurochir.1992; 53(1): 25–32.
13.
BarajasR.F.Jr, PhelpsA., FosterH.C.Metastatic diffuse intrinsic pontine glioma to the peritoneal cavity via ventriculoperitoneal shunt: case report and literature review.J Neurol Surg Rep.2015; 76(1): e91–e96.
14.
LeeM.H., LeeJ.I.Malignant ascites after subduroperitoneal shunt in a patient with leptomeningeal metastasis.J Korean Neurosurg Soc.2011; 50(4): 385–387.
15.
ZadaG., ChenT.C.A novel method for administering intrathecal chemotherapy in patients with leptomeningeal metastases and shunted hydrocephalus: case report.Neurosurgery.2010; 67(3 suppl): onsE306–onsE307.
16.
GwakH.S., LeeC.H., YangH.S.Chemoport with a non-collapsible chamber as a replacement for an Ommaya reservoir in the treatment of leptomeningeal carcinomatosis.Acta Neurochir (Wien).2011; 153(10): 1971–1978.
17.
GwakH.S., LeeS.H., ParkW.S.Recent advancements of treatment for leptomeningeal carcinomatosis. JKorean Neurosurg Soc.2015; 58(1): 1–8.
18.
GwakH.S., JooJ., ShinS.H.Ventriculolumbar perfusion chemotherapy with methotrexate for treating leptomeningeal carcinomatosis: a phase II study.Oncologist.2014; 19(10): 1044–1045.
19.
SouweidaneM.M., SandbergD.I., BilskyM.H.Endoscopic biopsy for tumors of the third ventricle.Pediatr Neurosurg.2000; 33(3): 132–137.
20.
MisakiK., UchiyamaN., HayashiY.Intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion-four case reports.Neurol Med Chir (Tokyo).2010; 50(1): 76–79.
21.
BleyerW.A., PizzoP.A., SpenceA.M.The Ommaya reservoir: newly recognized complications and recommendations for insertion and use.Cancer.1978; 41(6): 2431–2437.
22.
JacobsA., CliffordP., KayH.E.The Ommaya reservoir in chemotherapy for malignant disease in the CNS.Clin Oncol.1981; 7(2): 123–129.
23.
ObbensE.A., LeavensM.E., BealJ.W.Ommaya reservoirs in 387 cancer patients: a 15-year experience.Neurology.1985; 35(9): 1274–1278.
24.
ShapiroW.R., PosnerJ.B., UshioY.Treatment of meningeal neoplasms.Cancer Treat Rep.1977; 61(4): 733–743.
25.
ShermanP.M., AygunN.Development of a cavum septi pellucidi after Ommaya reservoir placement: report of an unusual complication.Acta Neurochir (Wien).2006; 148(3): 359–362.
26.
BrowneM.J., DinndorfP.A., PerekD.Infectious complications of intraventricular reservoirs in cancer patients.Pediatr Infect Dis J.1987; 6(2): 182–189.
KramerK., SmithM., SouweidaneM.M.Safety profile of long-term intraventricular access devices in pediatric patients receiving radioimmuno-therapy for central nervous system malignancies.Pediatr Blood Cancer.2014; 61(9): 1590–1592.
29.
ChakrabortyA., DrakeJM, WarfB.C.Methods of cerebrospinal fluid diversion in pediatric hydrocephalus: from shunt to scope. In: Quinones-HinojosaA., ed. Schmidek and Sweet: Operative Neurosurgical Techniques: Indications, Methods, and Results.6th ed., vol. 1. Philadeiphia: Elsevier/Saunders; 2012.
30.
ViraraghavanR., JantauschB., CamposJ.Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management.Clin Pediatr (Phila).2004; 43(4): 393–397.
31.
GeorgeR., LeibrockL., EpsteinM.Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience.J Neurosurg.1979; 51(6): 804–811.
32.
SimonT.D., ButlerJ., WhitlockK.B.Hydrocephalus Clinical Research Network. Risk factors for first cerebrospinai fluid shunt infection: findings from a multi-center prospective cohort study.J Pediatr.2014; 164(6): 1462–1468.
33.
MurrayM.J., MetayerL.E., MallucciC.L.Intra-abdominal metastasis of an intracranial germinoma via ventriculo-peritoneal shunt in a 13-year-old female.Br J Neurosurg.2011; 25(6): 747–749.
34.
SenaF.G., SousaR.M., MeguinsL.C.Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in a Brazilian Amazon woman. Case report.G Chir.2010; 31(8-9): 371–373.
35.
BackM.R., HuB., RutgersJ.Metastasis of an intracranial germinoma through a ventriculoperitoneal shunt: recurrence as a yolk-sac tumor.Pediatr Surg Int.1997; 12(1): 24–27.
Aparici-RoblesF., Molina-FabregaR.Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults.J Med Imaging Radiat Oncol.2008; 52(1): 40–43.
38.
HaimovicI.C., SharerL., HymanR.A.Metastasis of intracranial germinoma through a ventriculoperitoneal shunt.Cancer.1981; 48(4): 1033–1036.
39.
UchinoM., NemotoM., OhtsukaT.Extraneural metastasis of pineal germinoma through a ventriculoperitoneal shunt, following histological change. [Article in Japanese].No Shinkei Geka.1999; 27(3): 269–274.
40.
PudenzR.H., FoltzE.L.Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations.Surg Neurol.1991; 35(3): 200–212.
41.
SamuelsonS., LongD.M., ChouS.N.Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus.J Neurosurg.1972; 37(5): 548–551.
42.
SæhleT., FarahmandD., EideP.K.A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings.J Neurosurg.2014; 121(5): 1257–1263.
