Abstract
Leptomeningeal metastasis (LM) is caused by the spread of malignant tumor cells into the subarachnoid space. However, classification and staging of LM in the spinal canal is rare in the literature. The authors reviewed the records of 58 Chinese patients with LM for clinical features, neuroimaging, and treatments. Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spinal cord were performed in all patients. Removal of intracranial tumors was performed in all patients and diagnoses were confirmed by histology. The study group consisted of 58 patients, with 29 cases presenting with intraspinal symptoms. Of the 58, 8 patients underwent intraspinal tumor removal, 8 received radiotherapy alone, 9 received chemotherapy alone, and 34 patients received combined radiochemotherapy. We classified LM into 3 types: type L or leptomeninges LM, is subdivided into 2 subtypes (subtype LI and LII (a,b)), type N or nerve root LM is subdivided into 2 subtypes (subtype NI and NII (a,b)), and type M or mixed-type LM. We also divided LM into stages of I-IV according to the symptoms and the volume of the tumor based on spinal axial MRI. Type LI LM often occurs in patients with intracranial and intraspinal tumors found simultaneously. Patients who receive surgery for intracranial tumors may present with type N LM. Surgery is suitable for patients with NI LM and LIIb LM in stages III–IV, presenting with severe spinal symptoms. The prognosis is better for type N LM than type L LM.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Posner J B. Neurologic Complications of Cancer. Philadelphia, PA: F.A. Davis Company, 1995
Groves M D. The pathogenesis of neoplastic meningitis. Curr Oncol Rep, 2003, 5: 15–23
Seute T, Leffers P, ten Velde G P, et al. Leptomeningeal metastases from small cell lung carcinoma. Cancer, 2005, 104: 1700–1705
Kesari S, Batchelor T T. Leptomeningeal metastases. Neurol Clin, 2003, 21: 25–66
Kelly C B, Mauricio C N, Ricardo R, et al. Patterns of neuraxis dissemination of gliomas: Suggestion of a classification based on magnetic resonance imaging findings. Surg Neurol, 2006, 65: 472–477
Schiff D, O’Neill B P. Intramedullary spinal cord metastases: Clinical features and treatment outcome. Neurology, 1996, 47: 906–912
Boyle R, Thomas M, Adams J H. Diffuse involvement of the leptomeninges by tumor-A clinical and pathological study of 63 cases. Postgrad Med J, 1980, 56: 149–158
Vertosick F T, Selker R G. Brain stem and spinal metastases of supratentorial glioblastoma multiforma: A clinical series. Neurosurgery, 1990, 27: 516–522
Natale M, Spennato P, Savarese L, et al. Anaplastic oligodendroglioma presenting with drop metastases in the cauda equina. Clin Neurol Neurosurg, 2005, 107: 417–420
Wasserstrom W R, Glass J P, Posner J B. Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients. Cancer, 1982, 49: 759–772
Glass J P, Melamed M, Chernik N L, et al. Malignant cells in cerebrospinal fluid (CSF): The meaning of a positive CSF cytology. Neurology, 1979, 29: 1369–1375
Norris L K, Grossman S A, Olivi A. Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: A potentially preventable complication. J Neurooncol, 1997, 32: 215–223
van der Ree T C, Dippel D W, Avezaat C J, et al. Leptomeningeal metastasis after surgical resection of brain metastases. J Neurol Neurosurg Psychiatry, 1999, 66: 225–227
Mahajan A, Borden J, Tsai J S. Carcinomatous meningitis: Are surgery and gamma knife radiosurgery treatment risk factors? J Neurosurg, 2002, 97: 441–444
Kitaoka K, Abe H, Aida T, et al. Follow-up study on metastatic cerebellar tumor surgery-Characteristic problems of surgical treatment. Neurol Med Chir, 1990, 30: 591–598
Wippold F J, Smirniotopoulos J G, Pilgram T K. Lesions of the cauda equina: A clinical and pathology review from the Armed Forces Institute of Pathology. Clin Neurol Neurosurg, 1997, 99: 229–234
Zulch K J. Brain Tumors. Their Biology and Pathology. 3rd ed. Berlin: Springer, 1986
Gururangan S, McLaughlin C A, Brashears J, et al. Incidence and patterns of neuraxis metastases in children with diffuse pontine glioma. J Neurooncol, 2006, 77: 207–212
Saito R, Kumabe T, Jokura H, et al. Symptomatic spinal dissemination of malignant astrocytoma. J Neurooncol, 2003, 61: 227–235
O’Meara W P, Borkar S A, Stambuk H E, et al. Leptomeningeal metastasis. Curr Probl Cancer, 2007, 31: 367–424
Eran A, Ozturk A, Aygun N, et al. Medulloblastoma: Atypical CT and MRI findings in children. Pediatr Radiol, 2010, 40: 1254–1262
Balmaceda C, Gaynor J J, Sun M, et al. Leptomeningeal tumor in primary central nervous system lymphoma: Recognition, significance, and implications. Ann Neurol, 1995, 38: 202–209
Erlich S S, Davis R L. Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer, 1978, 42: 2854–2864
Enghelard H H. Current diagnosis and treatment of oligodendroglioma. Neurosurg Focus, 2002, 12: E2
Stüben G, Stuschke M, Kroll M, et al. Postoperative radiotherapy of spinal and intracranial ependymomas: Analysis of prognostic factors. Radiother Oncol, 1997, 45: 3–10
Lutterbach J, Fauchon F, Schild S E, et al. Malignant pineal parenchymal tumors in adult patients: Patterns of care and prognostic factors. Neurosurgery, 2002, 51: 44–56
Figueiredo E G, Matsushita H, Machado A G, et al. Leptomeningeal dissemination of pylocytic astrocytoma at diagnosis in childhood: Two cases report. Arq Neuropsiquiatr, 2003, 61: 842–847
Kahler R J, Coyne T. Treatment of an intracranial germinoma spinal metastasis. J Clin Neurosci, 1999, 6: 171–174
Schild S E, Scheithauer B W, Haddock M G, et al. Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer, 1996, 78: 2564–2571
Pasquier B, Gasnier F, Pasquier D, et al. Papillary meningioma. Clinicopathologic study of seven cases and review of the literature. Cancer, 1986, 58: 299–305
Kaltsas G A, Grossman A B. Malignant pituitary tumors. Pituitary, 1998, 1: 69–81
Akil H, Coupe N J, Singh J. Spinal deposits of a benign choroid plexus papilloma. J Clin Neurosci, 2008, 15: 708–712
Kaptanoglu E, Tun K, Celikmez R C, et al. Spinal drop metastasis of choroid plexus papilloma. J Clin Neurosci, 2007, 14: 381–383
Arnold P M, Habib A, Newell K, et al. Esthesioneuroblastoma metastatic to the thoracic intradural and extradural space. Spine J, 2009, 9: e1–e5
Chawla A, Emmanuel J V, Seow W T, et al. Paediatric PNET: Pre-surgical MRI features. Clin Radiol, 2007, 62: 43–52
Stacey L B, David G P. Advances in the treatment of meningeal cancers. Crit Rev Oncol Hematol, 1995, 20: 87–98
Dunbar S F, Barnes P D, Tarbell N J. Radiologic determination of the caudal border of the spinal field in cranial spinal irradiation. Int J Radiat Oncol Biol Phys, 1993, 26: 669–673
Herrlinger U, Förschler H, Küker W, et al. Leptomeningeal metastasis: Survival and prognostic factors in 155 patients. J Neurol Sci, 2004, 223: 167–178
Gleissner B, Chamberlain M C. Neoplastic meningitis. Lancet Neurol, 2006, 5: 443–452
Author information
Authors and Affiliations
Corresponding authors
Additional information
This article is published with open access at Springerlink.com
Electronic supplementary material
Rights and permissions
This article is published under an open access license. Please check the 'Copyright Information' section either on this page or in the PDF for details of this license and what re-use is permitted. If your intended use exceeds what is permitted by the license or if you are unable to locate the licence and re-use information, please contact the Rights and Permissions team.
About this article
Cite this article
Zhang, M., Ou, Y., Zhang, H. et al. Leptomeningeal metastasis from central nervous system tumors: A study of classification and stage in the spinal canal of 58 patients. Chin. Sci. Bull. 57, 2914–2919 (2012). https://doi.org/10.1007/s11434-012-5262-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11434-012-5262-4