Identifying the Preoperative Radiological Risk Features in Patients with Leptomeningeal Carcinomatosis Undergoing...

Area of Science:

• Neurology
• Neurosurgery
• Oncology

Background:

• Leptomeningeal carcinomatosis (LMC) presents a poor prognosis and rapid progression.
• Cerebrospinal fluid drainage (CSFD) is a critical intervention for managing intracranial hypertension and hydrocephalus in LMC patients.
• Identifying predictive radiological features for CSFD outcomes in LMC is crucial.

Purpose of the Study:

• To identify novel preoperative radiological features associated with outcomes in LMC patients undergoing CSFD.
• To evaluate the impact of specific radiological findings on survival after CSFD for LMC.

Main Methods:

• Retrospective review of 36 LMC patients with intracranial hypertension and hydrocephalus who underwent CSFD over 5 years.
• Analysis of preoperative radiological features, clinical characteristics, and survival times.
• Kaplan-Meier survival analysis to compare outcomes based on radiological findings.

Main Results:

• Median survival after CSFD was 5 months. Patients with cerebellar enhancement (25%) had shorter survival.
• Supratentorial cerebral edema was present in 66.7% of patients, with disproportionately enlarged subarachnoid space hydrocephalus (DESH) features in 38.9%.
• Cerebellar swelling (11.1%) was associated with a median survival of 0.27 months.

Conclusions:

• Radiological features of cerebellar enhancement correlate with shorter postoperative survival in LMC patients undergoing CSFD.
• Patients with DESH features may benefit from CSFD, experiencing longer survival compared to those with global cerebral edema.
• CSFD should be approached with caution in patients exhibiting cerebellar swelling, as it is associated with significantly poorer outcomes.