Intraventricular medication with or without ventricular shunt for leptomeningeal metastases with different intracranial pressure: A single-center, large-scale retrospective study

Shihao Zhao; Peng Sun; Xinrui Zhang; Jingwei Cao; Alphonce M K Nyalali; Yongqiang Hou; Xiangji Meng; Jun Xu; Yufang Zhu; Feng Li

doi:10.1016/j.wneu.2024.12.003

Intraventricular medication with or without ventricular shunt for leptomeningeal metastases with different intracranial pressure: A single-center, large-scale retrospective study

World Neurosurg. 2024 Dec 9:S1878-8750(24)01994-6. doi: 10.1016/j.wneu.2024.12.003. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Affiliated Cancer Hospital of Shandong First Medical University, China; Graduate School of Shandong First Medical University (Shandong Academy of Medical Sciences).
² Department of Neurosurgery, Affiliated Cancer Hospital of Shandong First Medical University, China.
³ School of Nursing and Rehabilitation, Shandong University.
⁴ Department of Neurosurgery, Affiliated Cancer Hospital of Shandong First Medical University, China. Electronic address: lifeng@sdfmu.edu.cn.

PMID: 39662621
DOI: 10.1016/j.wneu.2024.12.003

Abstract

Objectives: To evaluate the efficacy and prognosis of intraventricular medication administered via the reservoir of Ommaya or ventricular shunt system to control leptomeningeal metastases, with or without ventricular shunt based on intracranial pressure, in combination with postoperative systemic therapy.

Methods: Between April 2021 and December 2022, 125 patients with leptomeningeal metastases were managed in our department who underwent Ommaya reservoir placement and/or ventricular shunt and subsequently received intraventricular medication postoperatively. The extent of symptom amelioration and survival, as well as the determinants influencing prognosis, were evaluated. The 3-month, 6-month, and 1-year survival rates and mOS of the patients were calculated by the Kaplan‒Meier method, and survival and prognostic analyses were performed using the log-rank test, one-way analysis of variance, and the Cox proportional hazards model.

Results: Symptoms were significantly alleviated among the 113 leptomeningeal metastases with intracranial hypertension who underwent ventricular shunt placement. The median survival time of 112（89.6%）cases who received medication regularly was 9.0 months, and significantly prolonged by 2-4 months compared with that of other studies not involving intraventricular medication in the literature. Cox multifactorial analysis revealed that postoperative administration of intraventricular medication and the number of intraventricular medication times independently influenced the efficacy of leptomeningeal metastases treatment.

Conclusions: For leptomeningeal metastases, ventricular shunt not only significantly alleviates symptoms caused by intracranial hypertension but also avoids sudden death for those with severe intracranial hypertension. However, ventricular shunt placement only does not improve overall survival. Intraventricular medications controls effectively leptomeningeal metastases, significantly prolongs survival, enhances quality of life.

Keywords: intracranial hypertension; intraventricular medication; leptomeningeal metastasis; prognosis; ventricular shunt.