title: Palliative lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus: A case series.
abstract: Leptomeningeal metastasis-related hydrocephalus causes distress to patients with end-stage cancer through headache and other symptoms by elevating intracranial pressure, thus reducing quality of life. Ventriculoperitoneal shunt has been used as a treatment option in palliative care. We review four cases of patients who underwent lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus.
  
  
  
  All patients suffered from severe headache and nausea. The primary lesion was histologically diagnosed as lung adenocarcinoma in each case. The duration from diagnosis to onset of hydrocephalus symptoms ranged from 0 to 52 (mean 26) months. Cerebrospinal fluid pressure in every case was above the normal range due to high intracranial pressure. Case management: Conventional procedures for lumboperitoneal shunt were employed for all patients. Adjustable pressure valves were retrofitted into the shunt system. Case outcome: Three patients demonstrated significant improvement of clinical symptoms and quality of life after placement of lumboperitoneal shunts. In two cases, not only did performance status improve to independent daily activity but also comparatively long-term survival was achieved due to subsequent chemotherapies after surgery. No symptoms of peritoneal dissemination by floating cancer cells in cerebrospinal fluid were seen in any patients.
  
  
  
  Lumboperitoneal shunt appears to improve quality of life if the patient is suffering from symptoms of leptomeningeal metastasis-related hydrocephalus. Compared to ventriculoperitoneal shunt, lumboperitoneal shunt is less invasive and simpler, providing a suitable option for frail patients with end-stage cancer. Adjustable pressure shunt valves can cope with varying symptoms and ventricle sizes.
authors.affiliation: 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yamashiro
authors.affiliation: 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hitoshi
authors.affiliation: 2 Department of Neurosurgery, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Tajiri
authors.affiliation: 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Uchikawa
authors.affiliation: 3 Department of Internal Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Ito
authors.affiliation: 1 Department of Neurosurgery, Kumamoto Rosai Hospital, Kumamoto, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: 4 Department of Neurosurgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Kuratsu
mesh_terms: D000368:Aged; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000628:therapy*; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000556:secondary*; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life
keywords: Leptomeningeal metastasis; adjustable pressure valve; case series; lumboperitoneal shunt; palliative care