Strik H, Prömmel P
Neurologische Klinik Philipps Universität Marburg, Rudolf Bultmann Strasse 8, Marburg.
Nervenarzt. 2010 Feb;81(2):229-41; quiz 242. doi: 10.1007/s00115-009-2927-6.
Neoplastic meningitis is a diffuse dissemination of tumour cells in the cerebrospinal fluid (CSF), leptomeninges, or both. It occurs in approximately 5-10% of malignant diseases, most often in breast cancer, lung cancer, melanoma, and B-cell lymphoma. Symptoms of neoplastic meningitis include head or back pain, cranial nerve palsies, diffuse radicular symptoms, and psychiatric disturbances. Magnetic resonance imaging shows nodular contrast enhancement lining the CSF spaces. Positive CSF cytology requires optimal sampling and processing, and the treatment of neoplastic meningitis must be individualized. The CSF dissemination can be treated with intrathecal chemotherapy with methotrexate or Ara-C. Radiotherapy should be applied only to symptomatic solid spinal manifestations or fast progressing cranial nerve palsies. Systemic chemotherapy is needed to control solid manifestations or, in the case of substances entering the CSF, to support intrathecal chemotherapy.
肿瘤性脑膜炎是肿瘤细胞在脑脊液（CSF）、软脑膜或两者中弥漫性播散。它约发生于5% - 10%的恶性疾病中，最常见于乳腺癌、肺癌、黑色素瘤和B细胞淋巴瘤。肿瘤性脑膜炎的症状包括头痛或背痛、颅神经麻痹、弥漫性神经根症状和精神障碍。磁共振成像显示沿脑脊液间隙的结节状对比增强。脑脊液细胞学检查呈阳性需要最佳的采样和处理，肿瘤性脑膜炎的治疗必须个体化。脑脊液播散可用甲氨蝶呤或阿糖胞苷鞘内化疗。放疗仅适用于有症状的脊柱实体表现或快速进展的颅神经麻痹。需要全身化疗来控制实体表现，或者在有物质进入脑脊液的情况下，支持鞘内化疗。
