Andrey A Volkov1, Andreas K Filis2, Frank D Vrionis3. 1. Neuro-Oncology Program, Moffitt Cancer Center, Tampa, FL. 2. Imland Klinik, Rendsburg, Germany. andreasfilis79@yahoo.de. 3. Marcus Neuroscience Institute, Boca Raton Regional Hospital and the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL. fvrionis@brrh.com.
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.
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.
Authors: Michael C Burger; Marlies Wagner; Kea Franz; Patrick N Harter; Oliver Bähr; Joachim P Steinbach; Christian Senft Journal: J Clin Med Date: 2018-08-14 Impact factor: 4.241
Authors: Eric W Sankey; Vadim Tsvankin; Matthew M Grabowski; Gautam Nayar; Kristen A Batich; Aida Risman; Cosette D Champion; April K S Salama; C Rory Goodwin; Peter E Fecci Journal: Cancer Med Date: 2019-09-30 Impact factor: 4.452