Palliative shunt surgery for patients with leptomeningeal metastasis

Publication date: Available online 12 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Yuta Murakami, Masahiro Ichikawa, Mudathir Bakhit, Shinya Jinguji, Taku Sato, Masazumi Fujii, Jun Sakuma, Kiyoshi Saito
ObjectivesLeptomeningeal metastasis (LM) is associated with poor prognosis and affects the quality of life (QOL) of end-stage cancer patients. Severe headache associated with hydrocephalus causes reduced QOL. We investigated the clinical value of surgical treatment for hydrocephalus in LM patients.Patients and methodsThe medical records of 11 consecutive patients who underwent lumboperitoneal shunt (LPS) or ventriculoperitoneal shunt (VPS) at our institution between 2007 and 2016 were investigated. Primary brain tumor patients were excluded. We assessed the neurological status and therapeutic effects at 1 month after the shunt surgery.ResultsThe patients were three males and eight females with a median age of 58 years (interquartile range [IR] 52 to 68 years). The median preoperative neutrophil-to-lymphocyte ratio was 6.4 (IR 4.8 to 9.2). Symptom improvement was observed in nine patients, and severe headache was relieved in seven (88%) out of eight patients. The median Karnofsky performance status scale increased from 40 to 60, and the median overall survival after primary malignancy diagnosis was 27.4 months (IR 19.6 to 63.1 months). The median survival after the diagnosis of brain parenchymal metastasis, LM, and shunt surgery were 7.2 months (IR 5.1 to 14.1 months), 3.9 months (IR 3.5 to 6.3 months), and 3.3 months (IR 2.9 to 5.7 months), respectively.ConclusionShunt surgery for hydrocephalus could offer an effective palliative surgical option for symptom relief especially relief of severe headache, contributing improvement of QOL in LM patients.



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