Cerebrospinal Fluid Dissemination and Neoplastic Meningitis in Primary Brain Tumors

Abstract

Background: Neoplastic meningitis, also known as leptomeningeal disease, affects the entire neuraxis. The clinical manifestations of the disease may affect the cranial nerves, cerebral hemispheres, or the spine. Because of the extent of disease involvement, treatment options and disease staging should involve all compartments of the cerebrospinal fluid (CSF) and subarachnoid space. Few studies of patients with primary brain tumors have specifically addressed treatment for the secondary complication of neoplastic meningitis. Therapy for neoplastic meningitis is palliative in nature and, rarely, may have a curative intent. Methods: A review of the medical literature pertinent to neoplastic meningitis in primary brain tumors was performed. The complication of neoplastic meningitis is described in detail for the various types of primary brain tumors. Results: Treatment of neoplastic meningitis is complicated because determining who should receive aggressive, central nervous system (CNS)-directed therapy is difficult. In general, the therapeutic response of neoplastic meningitis is a function of CSF cytology and, secondarily, of the clinical improvement in neurological manifestations related to the disease. CSF cytology may manifest a rostrocaudal disassociation; thus, consecutive, negative findings require that both lumbar and ventricular cytological testing are performed to confirm the complete response. Based on data from several prospective, randomized trials extrapolated to primary brain tumors, the median rate of survival for neoplastic meningitis is several months. Oftentimes, therapy directed at palliation may improve quality of life by protecting patients from experiencing continued neurological deterioration. Conclusions: Neoplastic meningitis is a complicated disease in which response to therapy varies by histology. Thus, survival rates after CNS-directed therapy will differ by the underlying primary tumor. Optimal therapy of neoplastic meningitis is poorly defined, and few guidelines exist to guide clinicians on the most appropriate choice of therapy.

Neoplastic meningitis: A study from a Tertiary Care Hospital from coastal India

“…In our study we did not find any case of primary brain tumor with metastasis to CSF. However, other studies[ 19 20 ] have seen a predominance (86%) of pediatric brain tumors with metastasis to CSF.…”

Symptoms, Diagnosis and Treatment of Hemangioblastoma Dissemination

“…The research a s s i s t e d t o re p re s e n t t h a t p ro p e n s i t y o f dissemination of these tumors through CSF by BNCT had increased. A review that was performed on neoplastic meningitis and cerebrospinal fluid dissemination in primary brain tumors showed that CSF cytology results in neoplastic meningitis' therapeutical response [17]. The study indicates that the survival rates of the tumor patients after the central nervous system directed therapy differs depending on the primary conditions and that there is a need of new method adoption for the optimal treatment neoplastic meningitis, as it has been poorly explained.…”

Neoplastic meningitis in solid tumors: from diagnosis to personalized treatments

“…7 Furthermore, NM is diagnosed in 1-2% of patients with primary brain tumors, such as ependymomas, medulloblastomas, germinomas and gliomas. 8 In more than 70% of patients NM develops in the setting of an active systemic disease, while in 20% of patients it occurs in association with a stable disease, and in up to 10% of patients it is the first manifestation of cancer. Some risk factors for developing NM have been recognized: concomitant brain metastases are associated with NM in 33-54% of patients with breast cancer, 56-82% with lung cancers and 87-96% with melanomas.…”