Cerebrospinal metastases in malignant childhood astrocytomas

Over a period of five years, antemortem diagnosis of leptomeningeal spread was made in six of thirteen children with high grade astrocytomas. These included four of seven children with hemispheral tumors and two of six children with malignant brainstem gliomas. Leptomeningeal spread was diagnosed by the clinical picture and CSF profile. Meningeal spread occurred an average of 5 months (range 0-16) after initial diagnosis of tumor was made. Several patients responded well to local radiation and/or chemotherapy. Mean survival after evidence of meningeal spread was 7 months (range 2-16) with one patient still alive. Meningeal spread of malignant childhood astrocytomas appears to be common and should be sought for in these patients as local radiation is beneficial. Serious consideration should be given to a controlled trial of prophylactic craniospinal radiation in three tumors. The role of chemotherapy also requires further study.