Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
Acta Neurochir (Wien). 2022 Feb;164(2):459-467. doi: 10.1007/s00701-021-04763-w. Epub 2021 Mar 1.
To investigate the outcomes of cerebrospinal fluid (CSF) diversion in lung cancer patients with leptomeningeal carcinomatosis (LMC).
A retrospective review of consecutive lung cancer patients with LMC suffering from increased intracranial pressure (IICP) and hydrocephalus between February 2017 and February 2020. We evaluated the survival benefit of CSF diversion surgery and assessed the outcomes of treatments administered post-LMC in terms of overall survival and shunt-related complications.
The study cohort included 50 patients (median age: 59 years). Ventricular peritoneal (VP) shunts were placed in 33 patients, and lumbar peritoneal (LP) shunts were placed in 7 patients. Programmable shunts were placed in 36 patients. Shunt adjustment was performed in 19 patients. Kaplan-Meier analysis revealed that shunt placement increased overall survival from 1.95 months to 6.21 months (p = 0.0012) and increased Karnofsky Performance Scores (KPS) from 60 to 70. Univariate analysis revealed no difference between VP or LP shunts in terms of survival. No differences in post-shunt systemic treatments (tyrosine kinase inhibitors (TKIs) or systemic treatments) were observed in overall survival. Shunt-related complications were noted in 7 patients, including shunt obstruction (n = 4), infection (n = 1), and over-drainage (n = 2).
CSF diversion (VP or LP shunt) appears to be an effective and safe treatment for lung cancer patients with LMC and hydrocephalus. Programmable shunts should be considered for complex cases, which commonly require pressure adjustments as the disease progresses.
研究肺癌伴软脑膜癌病（LMC）患者行脑脊液分流术的结果。
回顾性分析 2017 年 2 月至 2020 年 2 月连续收治的伴有颅内压升高（ICP）和脑积水的肺癌伴 LMC 患者。我们评估了 CSF 分流术的生存获益，并根据总生存和分流相关并发症评估了 LMC 后治疗的结果。
研究队列包括 50 例患者（中位年龄：59 岁）。33 例行脑室腹腔（VP）分流术，7 例行腰椎腹腔（LP）分流术。36 例行可编程分流术，19 例行分流调整。Kaplan-Meier 分析显示，分流术可将总生存时间从 1.95 个月延长至 6.21 个月（p = 0.0012），Karnofsky 表现评分（KPS）从 60 分提高至 70 分。单因素分析显示，VP 或 LP 分流术在生存方面无差异。在总生存方面，分流术后的全身治疗（酪氨酸激酶抑制剂（TKI）或全身治疗）无差异。7 例患者出现分流相关并发症，包括分流管阻塞（n = 4）、感染（n = 1）和过度引流（n = 2）。
CSF 分流术（VP 或 LP 分流术）似乎是肺癌伴 LMC 和脑积水患者的一种有效且安全的治疗方法。对于复杂病例，应考虑使用可编程分流术，因为随着疾病的进展，通常需要调整压力。
