Identifying the Preoperative Radiological Risk Features in Patients with Leptomeningeal Carcinomatosis Undergoing Cerebrospinal Fluid Drainage

Qinhan Hou; Yong Mo; Jinglin Guo; Teng Deng; Ligen Mo; Changyuan Wei

doi:10.1016/j.wneu.2024.04.014

Identifying the Preoperative Radiological Risk Features in Patients with Leptomeningeal Carcinomatosis Undergoing Cerebrospinal Fluid Drainage

World Neurosurg. 2024 Apr 7:S1878-8750(24)00577-1. doi: 10.1016/j.wneu.2024.04.014. Online ahead of print.

Authors

Qinhan Hou¹, Yong Mo¹, Jinglin Guo¹, Teng Deng¹, Ligen Mo¹, Changyuan Wei²

Affiliations

¹ Department of Neurosurgery, Guangxi Medical University Cancer Hospital, Nanning, China.
² Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China. Electronic address: changyuanwei@gxmu.edu.cn.

PMID: 38593911
DOI: 10.1016/j.wneu.2024.04.014

Abstract

Background: Patients with leptomeningeal carcinomatosis (LMC) experience a poor prognosis and rapid progression, and cerebrospinal fluid drainage (CSFD) is used to manage intracranial hypertension and hydrocephalus in LMC patients. This study aims to describe a novel discovery of preoperative radiological features in patients who underwent CSFD for LMC.

Methods: A retrospective review was conducted during the past 5 years of LMC patients with intracranial hypertension and hydrocephalus who underwent CSFD. We evaluated the patients' preoperative radiological features, clinical characteristics, and survival times.

Results: A total of 36 patients were included. Of the 36 patients, 34 underwent ventriculoperitoneal shunting, and 2 patients underwent only external ventricular drainage due to rapid progression. The median preoperative Karnofsky performance scale score was 40.0 (interquartile range [IQR], 20.0-40.0). The median survival time after surgery was 5 months (IQR, 0.00-10.43 months). Of the 36 patients, 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 month (IQR, 0.00-0.56 month). Nine patients (25%) have enhancement lesions on the cerebellum. The 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 with those with global cerebral edema.

Conclusions: Patients with radiological features of cerebellar enhancement have shorter postoperative survival than other patients; however, those with supratentorial cerebral edema, especially features of DESH, could benefit from CSFD. Patients with cerebellar swelling should avoid undergoing CSFD.

Keywords: Brain metastases; Carcinomatous leptomeningitis; Ventriculoperitoneal shunt.