Patients with Leptomeningeal Carcinomatosis and Hydrocephalus-Feasibility of Combined Ventriculoperitoneal Shunt and Reservoir Insertion for Intrathecal Chemotherapy.
Matthias SchneiderChristian WispelAnna-Laura PotthoffMuriel HeimannValeri BorgerChristina SchaubUlrich HerrlingerHartmut VatterPatrick SchussNiklas SchäferPublished in: Current oncology (Toronto, Ont.) (2024)
Therapeutic management of patients with leptomeningeal carcinomatosis (LC) may require treatment of concomitant hydrocephalus (HC) in addition to intrathecal chemotherapy (ITC). Ventriculoperitoneal shunts (VPS) equipped with a valve for manual deactivation of shunt function and a concomitant reservoir for application of ITC pose an elegant solution to both problems. The present study evaluates indication, feasibility, and safety of such a modified shunt/reservoir design (mS/R). All patients with LC aged ≥ 18 years who had undergone mS/R implantation between 2013 and 2020 at the authors' institution were further analyzed. ITC was indicated following the recommendation of the neuro-oncological tumor board and performed according to a standardized protocol. Sixteen patients with LC underwent mS/R implantation for subsequent ITC and concomitant treatment of HC. Regarding HC-related clinical symptoms, 69% of patients preoperatively exhibited lethargy, 38% cognitive impairment, and 38% (additional) visual disturbances. Postoperatively, 86% of patients achieved subjective improvement of HC-related symptoms. Overall, postoperative complications occurred in three patients (19%). No patient encountered cancer treatment-related complications. The present study describes a combination procedure consisting of a standard VPS-system and a standard reservoir for patients suffering from LC and HC. No cancer treatment-related complications occurred, indicating straightforward handling and thus safety.
Keyphrases
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- mass spectrometry
- randomized controlled trial
- peritoneal dialysis
- prognostic factors
- squamous cell carcinoma
- cognitive impairment
- heart failure
- physical activity
- depressive symptoms
- subarachnoid hemorrhage
- coronary artery
- radiation therapy
- left ventricular
- pulmonary artery
- sleep quality
- pulmonary hypertension
- aortic stenosis
- rectal cancer
- robot assisted
- transcatheter aortic valve replacement
- solid phase extraction