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Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: A potentially preventable complication

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Abstract

Neoplastic meningitis (NM) occurs in approximately 8% of all cancer patients. To confirm a clinical impression that NM is relatively common in patients who undergo surgical resection of an isolated cerebellar metastasis (ICM), a retrospective studywas performed. All patients who underwent a surgical resection of an isolated CNS metastasis at The Johns Hopkins Hospital betweenJanuary 1991 and June 1993 were identified. Their charts, laboratoryand pathologic data, radiologic studies, survival andcause of death were reviewed. A total of 66 patients were identified. Fifty-five patients underwent a surgical resectionof a supratentorial metastasis while 11 patients (6 females and5 males) underwent a surgical resection of an isolated cerebellarmetastasis. The ages of patients with cerebellar metastases rangedfrom 23 to 74 years at the time of diagnosis with a median age of49 years. All 11 patients had stable systemic disease and an excellent performance status. Five patients had tumors from lung,2 from breast, and 4 from other sites. Each was expected to have a long survival. However, 4 of the 11 patients (36%)developed unequivocal NM at 1, 3, 6, and 7 months following surgicalresection and all died within 1 month from the diagnosisof NM. Two patients had a positive CSF cytology and the other two had multiple enhancing leptomeningeal metastases on MRI. Two additionalpatients died of progressive neurological disease without evidence of local recurrence, yet were never formally evaluated for NM and two were lost to follow-up. Thus, the incidence of NM in this patient population is at least 36%. In the 55 patientswho had resections of supratentorial metastases, only 1 patient (2%) developed NM. This study suggests thatNM following surgical resection of an ICM may be common and mayresult in the premature demise of patients with excellent performancestatus, minimal systemic disease, and a reasonable life expectancy.Further studies are needed to determine if prophylacticintrathecal chemotherapy administered perioperatively could diminish the incidence of clinically apparent NM in this patient population.

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Authors and Affiliations

  1. Departments of Oncology, Medicine and Neurosurgery, The Johns Hopkins Oncology Center, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Lea K. Norris, Stuart A. Grossman & Alessandro Olivi

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  1. Lea K. Norris
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  2. Stuart A. Grossman
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  3. Alessandro Olivi
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Norris, L.K., Grossman, S.A. & Olivi, A. Neoplastic meningitis following surgical resection of isolated cerebellar metastasis: A potentially preventable complication. J Neurooncol 32, 215–223 (1997). https://doi.org/10.1023/A:1005723801479

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