Alhalabi Obada T, Klein Lukas, Wasilewski David, Mellal Amine, Büsken Carmen, Buszello Clara, Cossu Giulia, Eyüpoglu Ilker Y, Unterberg Andreas W, Vajkoczy Peter, Schackert Gabriele, Messerer Mahmoud, Misch Martin, Kessler Tobias, Wick Wolfgang, Jungk Christine, El Damaty Ahmed, Krieg Sandro M, Juratli Tareq A, Younsi Alexander
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Medical Faculty, Heidelberg University, Heidelberg, Germany.
Int J Cancer. 2025 Oct 15;157(8):1613-1624. doi: 10.1002/ijc.35505. Epub 2025 Jun 4.
Leptomeningeal disease (LMD) represents a terminal condition of tumor cell seeding that can cause symptomatic hydrocephalus. With improved survival rates under systemic therapy, the role of cerebrospinal fluid (CSF) drainage through ventriculo-peritoneal shunt (VPS) or Rickham reservoir (RR) placement in LMD patients is gaining more relevance. This study aimed to compare outcomes of both modalities in a multicentric contemporary cohort. A retrospective analysis of medical charts in patients receiving VPS for LMD and malresorptive hydrocephalus in two neurosurgical centers between 2006 and 2021 yielded 64 patients. The most common underlying oncological conditions were breast (n = 32, 49%) and non-small cell lung cancer (NSCLC, n = 16, 25%). The median time between primary and LMD diagnosis was 23.3 months (11.2 to 43.4 months). Symptoms of intracranial hypertension were relieved in 79% of cases (n = 50) after shunting, with 42 (66%) and 32 patients (50%) receiving systemic and intrathecal therapy, respectively. A further multicenter analysis comparing patients receiving VPS with patients receiving RR (with regular tapping) included 155 patients (VPS: n = 80, 52%; RR: n = 75, 48%). Compared to VPS, RRs were associated with a lower surgical revision rate (8% vs. 24%, p = 0.009). There was no difference in median overall survival in VPS patients (118 days) compared to RR patients (80 days, p = 0.180). Given this data showing a short and comparable survival of patients under both modalities with a lower RR complication rate, a rationale for an initial Rickham implantation in LMD patients with hydrocephalus, with later VPS conversion for long-term surviving patients, could be contemplated.
软脑膜疾病（LMD）是肿瘤细胞播散的终末期疾病，可导致症状性脑积水。随着全身治疗生存率的提高，通过脑室-腹腔分流术（VPS）或置入里克姆贮液器（RR）进行脑脊液（CSF）引流在LMD患者中的作用越来越重要。本研究旨在比较这两种方式在多中心当代队列中的疗效。对2006年至2021年期间在两个神经外科中心接受VPS治疗LMD和吸收不良性脑积水患者的病历进行回顾性分析，共纳入64例患者。最常见的潜在肿瘤疾病是乳腺癌（n = 32，49%）和非小细胞肺癌（NSCLC，n = 16，25%）。初次诊断与LMD诊断之间的中位时间为23.3个月（11.2至43.4个月）。分流术后79%的病例（n = 50）颅内高压症状得到缓解，其中42例（66%）和32例患者（50%）分别接受了全身治疗和鞘内治疗。另一项多中心分析比较了接受VPS的患者与接受RR（定期穿刺）的患者，共纳入155例患者（VPS：n = 80，52%；RR：n = 75，48%）。与VPS相比，RR的手术翻修率较低（8%对24%，p = 0.009）。VPS患者的中位总生存期（118天）与RR患者（80天，p = 0.180）相比无差异。鉴于这些数据显示两种方式下患者的生存期短且相当，而RR并发症发生率较低，对于脑积水的LMD患者，可考虑初始植入里克姆贮液器，对于长期存活的患者后期转换为VPS。
