The incidence of leptomeningeal metastases is increasing, due to the improvement of the management and the overall survival of cancer patients. Although the diagnosis may be sometimes difficult to assess, an early treatment before the setting of neurological deficits is required in order to improve the quality of life of the patients. The median survival of untreated patients is 4 to 6 weeks. Specific treatment may prolong survival by several months. The treatment requires a combination of chemotherapy and targeted therapies administrated systemically or via intra-cerebrospinal fluid route, surgery and radiotherapy. Patient management is specific but requires a multidisciplinary approach, which may vary according to the characteristics of meningeal disease, the characteristics of primary tumors, the general condition of patients and previous lines of treatments.