Experience Of Surgery In Treatment For Meningeal Carcinomatosis

Objective: The aim of this study is to analyse the clinical data of patients diagnosed with Meningeal carcinomatosis(MC)and hydrocephalus,so as to explore the better treatments for such diseases.Methods: Patients diagnosed with Meningeal carcinomatosis(MC)and treated by surgery from October 2014 to December 2018 admitted to the second hospital of Hebei medical university neurology department were reported and the objective is to analyze the clinical features,characteristics of primary malignancies,laboratory findings,therapeutic methods,changes in KPS score and postoperative complications.Results: Of the 8 cases,six were females and two were males.The mean age of the patients was 59 years old.Preoperative clinical manifestations,such as headache,cranial nerves damage,confusion of consciousness,gait disorder,epilepsy,cognitive dysfunction and urination and defecation disorders were included.Malignant cells were found in 8 patients in CSF cytology test and the average pressure of lumbar puncture was increased in 7 patients before surgery.All patients had a confirmed diagnosis of primary tumor.At the time of surgery,they all had been diagnosed with MC and 6 patients showed hydrocephalus.One patient received ventriculoperitoneal shunt and one patient accepted lumboperitoneal shunt,the others underwent Ommaya reservoir.After surgery,7 patients had been treated by intrathecal chemotherapy.The postoperative symptom was improved in 8 patients,the change of average Karnofsky performance status(KPS)scale was from 36.25 to 58.75.The postoperative complications of the surgeries occurred in 3 patients and mean survival time from surgery to death was 4.68 months(1-13),and 2 patients are still alive.Conclusions:1.For patients with tumors accompanied by central nervous system symptoms and hydrocephalus,the possibility of MC should be alerted.Early detection,early intervention,and early surgical treatment is also necessary.2.Early surgical intervention can provide time and opportunities for other treatments.Regular intrathecal chemotherapy and the systemic treatment of tumors after surgery can help patients to have a longer survival time and better quality of life.3.During the operation,sterility should be strictly controlled,and repeated puncture should be avoided.