Background: Patients with leptomeningeal carcinomatosis (LMC) experience poor prognosis and rapid progression, and cerebrospinal fluid drainage (CSFD) is employed to manage intracranial hypertension (ICH) and hydrocephalus in LMC patients. This study aims to unveil a novel discovery of preoperative radiological features in patients who underwent CSFD for LMC.
Methods: A retrospective review was conducted over the past five years on LMC patients with ICH and hydrocephalus who underwent CSFD. We evaluated patients' preoperative radiological features, clinical characteristics, and survival time.
Results: A total of 36 patients were included. 34 patients underwent ventriculoperitoneal shunting (VPS), while 2 patients underwent only external ventricular drainage (EVD) due to rapid progression. The preoperative Karnofsky Performance Status (KPS) was 40.0 (IQR 20.0-40.0). The median survival time after surgery is 5 months (IQR 0.00-10.43). 24 (66.7%) had supratentorial cerebral edema before surgery, including 14 patients (38.9%) with features of Disproportionately enlarged subarachnoid space Hydrocephalus (DESH). Four patients (11.1%) exhibited cerebellar swelling and had a median survival time of 0.27 months (IQR 0.00-0.56). Nine patients (25%) have enhancement lesions on the cerebellum. Survival curve analysis shows that patients with features of cerebellar enhancement have shorter survival times than other patients. Patients with DESH features have longer survival times compared to those with global cerebral edema.
Conclusion: Patients with radiological features of cerebral enhancement have shorter postoperative survival time compared to other patients, whereas those with supratentorial cerebral edema especially the feature of DESH may benefit from CSFD. Cerebellar swelling patients should avoid undergoing CSFD.
Keywords: Brain metastases; Carcinomatous leptomeningitis; Ventriculoperitoneal Shunt.
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