Acute Hydrocephalus due to Secondary Leptomeningeal Dissemination of an Anaplastic Oligodendroglioma

Abstract

Secondary leptomeningeal dissemination of oligodendroglioma is very rare. We report the case of a 38-year-old Caucasian male who presented with acute hydrocephalus. 8 months before, the patient had undergone craniotomy for right frontal anaplastic oligodendroglioma, WHO grade III. By that time, there was no evidence of tumor dissemination. MRI now ruled out local tumor progression but revealed meningeal contrast enhancement along the medulla, the myelon, and the cauda equina. Repeated lumbar puncture revealed increased cerebro-spinal fluid (CSF) pressure and protein content. Malignant cells were not detectable. Surgical treatment consisted in (1) placement of an ommaya reservoir for daily CSF puncture, (2) Spinal dural biopsy confirming leptomeningeal oligodendroglioma metastasis, and (3) ventriculo-peritoneal shunt placement after CSF protein has decreased to 1500–2000 mg/l.

Anaplastic oligodendroglioma with leptomeningeal dissemination in a french bulldog

“…During CSF drop metastasis, the tumor extends through the ependyma and along the CSF pathway, and new lesions develop in a caudal direction, accompanied by the formation of tumor masses [ 14 , 28 , 30 ]. Leptomeningeal dissemination of oligodendroglioma and anaplastic oligodendroglioma has rarely been reported in humans [ 20 , 25 ]. In the present case, histopathological examination revealed tumor cells forming tumor foci along the meninges (under the pia mater).…”

Intraventricular Localization of an Anaplastic Oligodedendroglioma: A Rare Event

“…In our case, leptomeningeal gliomatosis can be easily ruled out by the absence of leptomeningeal thickening and enhancement 3,5,6,9 .…”

“…1,2 We report the case of a patient presenting with an intraventricular localization of oligodendroglioma, focusing on the multiple pathogenetic mechanisms. Different phenomena have been advocated in the intraventricular localization of oligodendroglioma: Ι) primary diffus leptomeningeal gliomatosis or oligodendrogliosis [3][4][5][6] ; ΙΙ) haematogenous spreading 7 ; ΙΙΙ) intraventricular seeding from a primary oligodendroglioma, either due to a CsF dissemination 7 or secondary to an invasive procedure such as surgery 2,7,8 .…”

Surgical Treatment for Leptomeningeal Disease

“…According to Stark et al,10 shunts should work even when the level of CSF protein is as high as 3000 mg/dL. Nonetheless, in our every-day practice, we would typically aspirate the CSF through the Ommaya reservoir for a few days until the protein level drops.…”