Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Neurooncol. 2011 Sep;104(2):545-51. doi: 10.1007/s11060-010-0512-2. Epub 2011 Jan 28.
The development of better diagnostic tools and therapeutic modalities has increased the incidence of central nervous system (CNS) metastasis in malignant tumor patients. Hydrocephalus can result from CNS metastasis and frustrate cancer treatment. The authors sought to investigate the outcomes and the roles of ventriculoperitoneal shunts (VPS) in patients with CNS metastasis. The medical records of 50 consecutive patients who underwent VPS for hydrocephalus related to CNS metastasis were analyzed retrospectively. Data included features of primary malignancies, CNS involvement, clinical course and surgical outcome. Median patient age was 55.0 years (range 25-77), and 30 female and 20 male patients were included in the study. At the time of VPS, 10 patients had parenchymal metastases only and 40 patients had leptomeningeal seeding (LMS). Symptom improvement was observed postoperatively in 40 patients (80%), mean Karnofsky performance status (KPS) scale change was from 37.8 to 46.0, and median survival from VPS was 3.0 months (2 days to 54 months). A ventricular opening pressure of >30 cmH(2)O (HR 6.44, 95% CI 1.26-32.9, P = 0.02) and further cancer treatment after VPS (HR 0.17, 95% CI 0.07-0.42, P < 0.0001) were found to be independent risk factors of poorer and better survival, respectively. Hydrocephalus in CNS metastasis requiring VPS is commonly associated with LMS. VPS is an effective palliative measure and an adequate cancer treatment after VPS may provide the best means of improving survival.
发展更好的诊断工具和治疗方式增加了恶性肿瘤患者中枢神经系统（CNS）转移的发生率。脑积水可由 CNS 转移引起，并使癌症治疗受阻。作者旨在研究 CNS 转移患者行脑室-腹腔分流术（VPS）的结果和作用。回顾性分析了 50 例因 CNS 转移相关脑积水而行 VPS 的连续患者的病历。数据包括原发性恶性肿瘤的特征、CNS 受累、临床过程和手术结果。患者中位年龄为 55.0 岁（范围 25-77 岁），包括 30 名女性和 20 名男性。在进行 VPS 时，10 例患者仅存在实质转移，40 例患者存在软脑膜播散（LMS）。40 例患者术后症状改善（80%），卡氏功能状态评分（KPS）平均从 37.8 分提高至 46.0 分，VPS 后中位生存时间为 3.0 个月（2 天至 54 个月）。发现脑室开放压>30cmH₂O（HR 6.44，95%CI 1.26-32.9，P=0.02）和 VPS 后进一步癌症治疗（HR 0.17，95%CI 0.07-0.42，P<0.0001）是生存率较差和较好的独立危险因素。需要 VPS 的 CNS 转移相关性脑积水通常与 LMS 相关。VPS 是一种有效的姑息治疗措施，VPS 后充分的癌症治疗可能是提高生存率的最佳方法。
