Surgical Treatment for Leptomeningeal Disease

Andrey A. Volkov, DO; Andreas K. Filis, MD; Frank D. Vrionis, MD, PhD

Disclosures

Cancer Control. 2017;24(1):47-53. 

In This Article

Abstract and Introduction

Abstract

Background. 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.

Introduction

Leptomeningeal disease has been traditionally considered an end-stage diagnosis, and the prognosis has been poor; however, progress in chemotherapeutic agents has led to more favorable outcomes.[1–3] Although there is rarely a solid tumor that exists in leptomeningeal carcinomatosis to resect, there is a role for neurosurgical intervention.

In this paper, we review our understanding of devices used to access to the ventricular system as well as shunt systems. We also provide an overview of the most common complications and discuss techniques such as neuronavigation that help minimize rates of morbidity and mortality from leptomeningeal disease.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....