Managing hydrocephalus in patients with leptomeningeal disease: A multicenter retrospective analysis.

IF 4.7 2区 医学 Q1 ONCOLOGY
Obada T Alhalabi, Lukas Klein, David Wasilewski, Amine Mellal, Carmen Büsken, Clara Buszello, Giulia Cossu, Ilker Y Eyüpoglu, Andreas W Unterberg, Peter Vajkoczy, Gabriele Schackert, Mahmoud Messerer, Martin Misch, Tobias Kessler, Wolfgang Wick, Christine Jungk, Ahmed El Damaty, Sandro M Krieg, Tareq A Juratli, Alexander Younsi
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引用次数: 0

Abstract

Leptomeningeal disease (LMD) represents a terminal condition of tumor cell seeding that can cause symptomatic hydrocephalus. With improved survival rates under systemic therapy, the role of cerebrospinal fluid (CSF) drainage through ventriculo-peritoneal shunt (VPS) or Rickham reservoir (RR) placement in LMD patients is gaining more relevance. This study aimed to compare outcomes of both modalities in a multicentric contemporary cohort. A retrospective analysis of medical charts in patients receiving VPS for LMD and malresorptive hydrocephalus in two neurosurgical centers between 2006 and 2021 yielded 64 patients. The most common underlying oncological conditions were breast (n = 32, 49%) and non-small cell lung cancer (NSCLC, n = 16, 25%). The median time between primary and LMD diagnosis was 23.3 months (11.2 to 43.4 months). Symptoms of intracranial hypertension were relieved in 79% of cases (n = 50) after shunting, with 42 (66%) and 32 patients (50%) receiving systemic and intrathecal therapy, respectively. A further multicenter analysis comparing patients receiving VPS with patients receiving RR (with regular tapping) included 155 patients (VPS: n = 80, 52%; RR: n = 75, 48%). Compared to VPS, RRs were associated with a lower surgical revision rate (8% vs. 24%, p = 0.009). There was no difference in median overall survival in VPS patients (118 days) compared to RR patients (80 days, p = 0.180). Given this data showing a short and comparable survival of patients under both modalities with a lower RR complication rate, a rationale for an initial Rickham implantation in LMD patients with hydrocephalus, with later VPS conversion for long-term surviving patients, could be contemplated.

脑膜轻脑病患者脑积水的处理:一项多中心回顾性分析。
轻脑膜病(LMD)代表肿瘤细胞播种的终末状态,可引起症状性脑积水。随着全身治疗下生存率的提高,脑脊液(CSF)通过脑室-腹膜分流(VPS)或Rickham储液池(RR)放置在LMD患者中的作用越来越重要。本研究旨在比较两种治疗方式在当代多中心队列中的结果。回顾性分析了2006年至2021年间在两个神经外科中心接受VPS治疗LMD和吸入性脑积水患者的病历,共发现64例患者。最常见的潜在肿瘤疾病是乳腺癌(n = 32,49%)和非小细胞肺癌(NSCLC, n = 16,25%)。原发性和LMD诊断之间的中位时间为23.3个月(11.2至43.4个月)。分流术后,79%的病例(n = 50)颅内高压症状得到缓解,其中42例(66%)和32例(50%)分别接受了全身和鞘内治疗。进一步的多中心分析比较了接受VPS的患者和接受RR(定期叩诊)的患者,包括155例患者(VPS: n = 80, 52%;RR: n = 75,48 %)。与VPS相比,rr与较低的手术翻修率相关(8%对24%,p = 0.009)。VPS患者的中位总生存期(118天)与RR患者(80天,p = 0.180)无差异。考虑到这一数据显示两种治疗方式下患者的生存时间都很短,且RR并发症发生率较低,可以考虑对LMD合并脑积水患者进行初始Rickham植入,对长期存活患者进行后期VPS转换的基本原理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
13.40
自引率
3.10%
发文量
460
审稿时长
2 months
期刊介绍: The International Journal of Cancer (IJC) is the official journal of the Union for International Cancer Control—UICC; it appears twice a month. IJC invites submission of manuscripts under a broad scope of topics relevant to experimental and clinical cancer research and publishes original Research Articles and Short Reports under the following categories: -Cancer Epidemiology- Cancer Genetics and Epigenetics- Infectious Causes of Cancer- Innovative Tools and Methods- Molecular Cancer Biology- Tumor Immunology and Microenvironment- Tumor Markers and Signatures- Cancer Therapy and Prevention
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