| Background: Meningitis metastasis, also called carcinomatous meningitis orleptomeningeal carcinomatosis, is a special of intracranial tumor. Though it is notmore than solid tumors and metastatic tumor of spinal cord, the autopsy confirmedthat the incidence of it still accounted for5%-8%of all patients and almost20%ofthose with neurological symptoms. Hydrocephalus occurs in a significant proportionof patients, is associated with poor prognosis and reduced quality of life, and ususllyprecludes the use of intrathecal thepary. Metastasis is one of the most seriouscomplications of cancer. The disease is rapidly, ususlly causing severe neuropathy insome patients, with the positive treatment still leads to death. Early diagnosis is veryimportant, because early treatment can save neural function, even if it can not extendsurvival, also may significantly improve or maintain a good quality of life. Thereforeimproving the understanding of the disease and early diagnosis is very important. It isa huge problem in our clinical work.Objective: So far, the treatment of meningitis metastasis is typically palliative,including surgery, systemic chemotherapy, intrathecal chemotherapy and localradiotherapy, etc. But now the ways to achieve the effect of the treatment is not ideal, so the treatment of carcinomatous meningitis remains controversial, and there is noguiding principle. Now, the target of the treatment of patients with meningitismetastasis is mainly to improve or stabilise neural function, prolong the survival,improve the quality of life. To investigate the clinical feature，diagnosis, therapies andprognosis of the high intracranial pressure caused by meningitis metastasis, explorethe role of ventriculoperitoneal shunt and intrathecal chemotherapy in the meningealmetastases, it can improve the understanding of the disease, and to provide the theorybasis for clinical treatment meningeal metastasis.Methods: A total of30consecutive diagnosed meningitis metastasispatients’whole saliva samples collected from Aug2009to Jul2011wereretrospectively reviewed and analyzed systematically: Male13cases, female17cases;Age44to63years, on average,56years old, the median age55years old;30patientsall underwent surgical placement of ventriculoperitoneal shunt construct to alleviateclinical symptoms, and23of them had Ommaya resercoir placed, and receivedintrathecal chemotherapy. The postoperative chemotherapy pumps into the cytarabine+dexamethasone, once or twice a week.Results:30patients were no perioperative mortality, and there was only1shunt-associated infection observed over a median of13months of follow-up.Symptomatic improvement and improved performance status were seen in22patients(73.3%) and were sustained over7months. In the cases,1patient was alive at end offollow-up. The median progression-free was20weeks (95%CI15.3-24.7, range4-32weeks). The median overall survival was10months (95%CI7.6-12.4, range3-96weeks). The observed median survival of10month in this study compared topublished studies reporting a median over-all survival of6month. Significantlyimprove the patient’s median survival.Conclusion: Ventriculoperitoneal cerebrospinal fluid shunting is safe andpractical to install, results in symptomatic improvement in most patients, and allows uncomplicated and effective administration of intrathecal chemotherapy in patientswith NM. All the patients underwent surgical placement of Ventriculoperitoneal shuntconstruct, and23of them had Ommaya resercoir placed, and received intrathecalchemotherapy. Our experience suggests that CSF diversion surgery in conjunctionwith intrathecal chemotherapy were effective at relieving the symptoms ofhydrocephalus. In the study, MRI combined with CSF cytology detection was helpfulto the diagnosis of this disease. Ventriculoperitoneal cerebrospinal fluid shunting andintraventricular chemotherapy should be considered having satisfactory efficacy forthese patients, and be worthy to be popularized. |
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