The potential of liquorpheresis to treat leptomeningeal disease

Abstract

Leptomeningeal disease (LMD) is a devastating sequela of many cancers with an extremely poor prognosis. Barriers to improving outcomes are related to the inability for many traditional therapies to effectively reach the cerebrospinal fluid (CSF) space within the central nervous system (CNS). Liquorpheresis is an emerging treatment modality specific to CSF pathologies, whose primary mechanism of action is direct targeted filtration of CSF content by neurosurgical access. In this review, we highlight the principles of liquorpheresis, and detail how LMD can be amenable to this for treatment. Further, we summarize the current in vitro and in vivo evidence supporting liquorpheresis as a feasible method to treat LMD and other CNS diseases, as well as describe its conceivable limitations.

Keywords: CSF; LMD; Liquorpheresis; cerebrospinal fluid; filtration; leptomeningeal disease.