Surgical Treatment for Leptomeningeal Disease

Волков, А.А.; Filis, Andreas; Vrionis, Frank D.

doi:10.1177/107327481702400107

Cited by 15 publications

(11 citation statements)

References 38 publications

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“…With the advances in systemic cancer treatment and prolonged patient survival, the incidence of leptomeningeal disease is rising . Certain metastatic cancers hold a predilection for leptomeningeal spread over others, with breast cancer carrying the highest risk .…”

Section: Operative Perioperative and Other Management Considerationsmentioning

confidence: 99%

“…No surgery directly treats leptomeningeal disease; however, as an alternative to serial lumbar punctures for drug delivery into the lumbar cistern, surgeons can place an Ommaya reservoir (a silicone reservoir attached to an intraventricular catheter) for delivery of intrathecal chemotherapy. Ommaya insertion has higher upfront risks as a surgical procedure, but allows for easier and less painful access to the cerebrospinal fluid space for chemotherapy administration in the outpatient setting while allowing for CSF sampling directly from the ventricle …”

Section: Operative Perioperative and Other Management Considerationsmentioning

confidence: 99%

“…With the advances in systemic cancer treatment and prolonged patient survival, the incidence of leptomeningeal disease is rising. 148 Certain metastatic cancers hold a predilection for leptomeningeal spread over others, with breast cancer carrying the highest risk. 100 No surgery directly treats leptomeningeal disease; however, as an alternative to serial lumbar punctures for drug delivery into the lumbar cistern, surgeons can place an Ommaya reservoir (a silicone reservoir attached to an intraventricular catheter) for delivery of intrathecal chemotherapy.…”

Section: The Role Of Surgery In Leptomeningeal Diseasementioning

confidence: 99%

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Operative and peri‐operative considerations in the management of brain metastasis

et al. 2019

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The number of patients who develop metastatic brain lesions is increasing as the diagnosis and treatment of systemic cancers continues to improve, resulting in longer patient survival. The role of surgery in the management of brain metastasis (BM), particularly multiple and recurrent metastases, remains controversial and continues to evolve. However, with appropriate patient selection, outcomes after surgery are typically favorable. In addition, surgery is the only means to obtain a tissue diagnosis and is the only effective treatment modality to quickly relieve neurological complications or life‐threatening symptoms related to significant mass effect, CSF obstruction, and peritumoral edema. As such, a thorough understanding of the role of surgery in patients with metastatic brain lesions, as well as the factors associated with surgical outcomes, is essential for the effective management of this unique and growing patient population.

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Section: Operative Perioperative and Other Management Considerationsmentioning

confidence: 99%

Section: Operative Perioperative and Other Management Considerationsmentioning

confidence: 99%

Section: The Role Of Surgery In Leptomeningeal Diseasementioning

confidence: 99%

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Operative and peri‐operative considerations in the management of brain metastasis

et al. 2019

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“…Such reservoirs are placed underneath the scalp in the frontal horn of the right lateral ventricle; a connecting catheter allows for communication between the device and CSF. Generally used for delivery of intrathecal chemotherapy in patients with leptomeningeal disease (LMD), they can also allow for CSF aspiration in the setting of high ICP [ 15 , 17 ]. Compared to LPs, repeated access to CSF is easier and more comfortable for patients with a reservoir.…”

Section: Current Surgical Optionsmentioning

confidence: 99%

“…However, reservoirs also come with possible complications, including infection, hemorrhage, or malpositioning [ 8 , 17 ]. Malpositioning rates range from 2.7 to 12.5% and can have serious consequences [ 8 , 17 , 18 ].…”

Section: Current Surgical Optionsmentioning

confidence: 99%

Management of hydrocephalus in patients with leptomeningeal metastases: an ethical approach to decision-making

et al. 2018

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PurposeLeptomeningeal metastases (LM) are a rare, but often debilitating complication of advanced cancer that can severely impact a patient’s quality-of-life. LM can result in hydrocephalus (HC) and lead to a range of neurologic sequelae, including weakness, headaches, and altered mental status. Given that patients with LM generally have quite poor prognoses, the decision of how to manage this HC remains unclear and is not only a medical, but also an ethical one.MethodsWe first provide a brief overview of management options for hydrocephalus secondary to LM. We then apply general ethical principles to decision making in LM-associated hydrocephalus that can help guide physicians and patients.ResultsManagement options for LM-associated hydrocephalus include shunt placement, repeated lumbar punctures, intraventricular reservoir placement, endoscopic third ventriculostomy, or pain management alone without intervention. While these options may offer symptomatic relief in the short-term, each is also associated with risks to the patient. Moreover, data on survival and quality-of-life following intervention is sparse. We propose that the pros and cons of each option should be evaluated not only from a clinical standpoint, but also within a larger framework that incorporates ethical principles and individual patient values.ConclusionsThe decision of how to manage LM-associated hydrocephalus is complex and requires close collaboration amongst the physician, patient, and/or patient’s family/friends/community leaders. Ultimately, the decision should be rooted in the patients’ values and should aim to optimize a patient’s quality-of-life.

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