Neoplastic Meningitis: A New Assessment of an Old Problem

Alan A Stein, Stephen Z Shapiro, Tabriez Babinchok-Cipot, Colin Niezgoda, Sajeel Chowdhary, MD, Frank D Vrionis, MD, MPH, PhD


Neoplastic meningitis (NM), also known as leptomeningeal carcinomatosis, is a complication of late stage malignancy, and is due to tumor infiltration of the leptomeninges and is found at autopsy in 5% of all cancer patients. The incidence of neoplastic meningitis is on the rise as the emergence of novel immunotherapeutic agents and continuous progress in modern cancer therapies increase overall survival rates of cancer patients. Diagnosis requires a high degree of clinical suspicion and is confirmed by the presence of leptomeningeal contrast enhancement on magnetic resonance imaging as well as confirmatory CSF cytology. Imaging may also reveal the presence of ventriculomegaly due to inflammatory changes inhibiting normal CSF circulation, resulting in a communicating hydrocephalus. Treatment is mainly palliative, primarily aimed at stabilizing patients neurological status and prolonging a meaningful quality of life. Current treatment regimens include intrathecal delivery of chemotherapy with or without the addition of fractionated radiation therapy. Most patients with NM, due to the extent of their disease and poor prognosis, are generally excluded from most clinical trials and investigational treatment options are limited to case reports and small case series. However, several current preclinical and clinical investigations are underway to examine the safety and efficacy of several promising new intrathecal agents.


Neoplastic meningitis; Leptomeningeal carcinomatosis; Chronic meningitis; Neurosurgery; Neurooncology

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