Department of Neurology, Phillips University, Rudolf Bultmann Strasse 8, D-35039 Marburg, Germany.
Expert Rev Anticancer Ther. 2010 Jul;10(7):1137-48. doi: 10.1586/era.10.86.
Neoplastic meningitis is a diffuse dissemination of tumor cells into the cerebrospinal fluid (CSF) and/or leptomeninges. It occurs in approximately 5-10% of malignant diseases, most often in breast cancer, lung cancer, melanoma or B-cell lymphoma. Symptoms of neoplastic meningitis are head or back pain, cranial nerve palsies, diffuse radicular symptoms or psychiatric disturbances. MRI shows nodular contrast enhancement lining CSF spaces. Positive CSF cytology requires optimal sampling and processing. Treatment must be individually shaped: the CSF dissemination may be treated with intrathecal chemotherapy with methotrexate or cytarabinoside (Ara-C). Liposomal Ara-C is distributed over the entire CSF space even after lumbar application and maintains cytotoxic levels for at least 2 weeks. 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.
癌性脑膜炎是指肿瘤细胞扩散到脑脊液（CSF）和/或软脑膜中。它发生在大约 5-10%的恶性疾病中，最常见于乳腺癌、肺癌、黑色素瘤或 B 细胞淋巴瘤。癌性脑膜炎的症状包括头痛或背痛、颅神经麻痹、弥漫性神经根症状或精神障碍。MRI 显示结节状对比增强脑脊液空间。阳性的 CSF 细胞学需要最佳的采样和处理。治疗必须个体化：CSF 播散可以用鞘内化疗治疗，药物包括甲氨蝶呤或阿糖胞苷（Ara-C）。脂质体阿糖胞苷即使在腰椎应用后也能分布在整个 CSF 空间，并保持至少 2 周的细胞毒性水平。放射治疗仅应用于有症状的实体脊柱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，或者在药物进入 CSF 的情况下，支持鞘内化疗。
