Chamberlain M C
Department of Neurosciences, University of California San Diego 92093-0812, USA.
J Child Neurol. 1995 May;10(3):191-9. doi: 10.1177/088307389501000304.
Leptomeningeal metastasis is an uncommon problem in pediatric neurology and oncology. It occurs primarily in children with acute lymphoblastic leukemia and primary brain tumors. Although leptomeningeal metastasis may present with focal neurologic signs and symptoms, leptomeningeal metastasis is a disease affecting the entire neuraxis and necessitating an extent-of-disease evaluation of both the brain and spinal cord. Neuroradiographic staging of leptomeningeal metastases includes contrast-enhanced cranial computed tomography, magnetic resonance imaging, contrast-enhanced spine magnetic resonance imaging or computed tomographic myelography, and radionuclide cerebrospinal fluid flow studies. As a consequence of global neuraxis involvement, the treatment of leptomeningeal metastases requires therapy directed at all cerebrospinal fluid compartments. The treatment of leptomeningeal metastases usually includes both radiotherapy and intra-cerebrospinal fluid drug therapy. Radiotherapy is directed to regions of bulky or symptomatic central nervous system disease. Intra-cerebrospinal fluid drug therapy, using one of three available chemotherapeutic agents (methotrexate, cytarabine, or triethylene thiophosphoramide), is administered by a variety of schedules and either by intralumbar or intraventricular drug delivery. Notwithstanding that the treatment of leptomeningeal metastases is palliative, with an expected patient survival of 6 months, it often affords stabilization and protection from further neurologic deterioration in children with leptomeningeal metastases in whom death is usually a consequence of progressive systemic or parenchymal brain disease.
软脑膜转移在儿童神经病学和肿瘤学中是一个不常见的问题。它主要发生在急性淋巴细胞白血病和原发性脑肿瘤患儿中。尽管软脑膜转移可能表现为局灶性神经体征和症状，但软脑膜转移是一种影响整个神经轴的疾病，需要对脑和脊髓进行疾病范围评估。软脑膜转移的神经影像学分期包括增强头颅计算机断层扫描、磁共振成像、增强脊柱磁共振成像或计算机断层脊髓造影，以及放射性核素脑脊液流动研究。由于整个神经轴受累，软脑膜转移的治疗需要针对所有脑脊液腔室进行治疗。软脑膜转移的治疗通常包括放疗和脑室内药物治疗。放疗针对中枢神经系统大块或有症状疾病的区域。脑室内药物治疗使用三种可用化疗药物（甲氨蝶呤、阿糖胞苷或硫替派）之一，通过多种方案给药，可通过腰椎或脑室内给药。尽管软脑膜转移的治疗是姑息性的，预期患者生存期为6个月，但它通常能使患有软脑膜转移的儿童病情稳定，并防止进一步神经功能恶化，在这些儿童中，死亡通常是进行性全身性或实质性脑部疾病的结果。
