What Is Leptomeningeal Carcinomatosis?

Leptomeningeal carcinomatosis, also called leptomeningeal metastases, is the spread of cancer cells that multiply within the cerebrospinal fluid in the leptomeninges—the pia mater and arachnoid membranes that line the brain. Usually the metastases are malignant growths that have spread from another area of the body, such as the lungs, breast, gastrointestinal or skin, but sometimes it can be the first instance of cancer.

Causes and Symptoms of Leptomeningeal Carcinomatosis

Leptomeningeal carcinomatosis occurs when cancer cells infiltrate the cerebrospinal fluid (CSF) and travel in the flow around the brain and the spinal fluid. Some of these malignant cells attach to the meninges, the brain’s lining.

Cerebral symptoms:

• headache—this is the most common symptom
• nausea and/or vomiting
• confusion
• coordination issues

Cranial nerve symptoms:

• vision problems such as double vision
• tinnitus (ringing in the ears) or hearing dysfunction
• numbness or weakness in the face
• problems with speech

Since the cerebrospinal fluid not only flows around the brain, but also the spinal cord, some of the symptoms of leptomeningeal metastases relate to the spinal cord:

• back or neck pain
• muscle weakness
• unsteady gait
• paralysis, often on one side
• bowel or bladder problems

Other severe symptoms of leptomeningeal carcinomatosis may include inflammation or tumors which hinder the flow of cerebrospinal fluid (CSF), which can lead to higher intracranial pressure and hydrocephalus.

How Is Leptomeningeal Carcinomatosis Diagnosed?

Neuroimaging using a gadolinium-enhanced MRI, analysis of the cerebrospinal fluid (CSF) using cytology and flow cytometry along with additional laboratory testing, medical history and neurological symptoms are used to diagnose leptomeningeal metastases.

Advanced Treatments for Leptomeningeal Carcinomatosis at NSPC

Treatments for leptomeningeal metastases are generally considered palliative, and are implemented to reduce symptoms, sustain neurogenic functioning, prolong life expectancy and improve quality of life. Neurological Surgery, P.C. (NSPC) is committed to providing the most advanced treatments, to offer the best possible results.

If a tumor has impeded your cerebrospinal fluid (CSF) flow and increased the intracranial pressure (ICP) or led to hydrocephalus, then reducing ICP by inserting a shunt in a ventrical in the brain may be required. Highly qualified neurosurgeons perform this procedure with the assistance of an expert surgical team, experienced in cranial surgeries.

The board-certified interventional neuroradiologists at NSPCl treat bulky or large tumors with state-of-the-art stereotactic radiotherapy. Image-guided stereotactic radiosurgery, such as Gamma Knife® or CyberKnife®, provide targeted radiation beams to the tumor site.

Chemotherapy drugs are directly put into the spinal fluid either via an Ommaya reservoir or a lumbar puncture. An Ommaya reservoir allows chemotherapy to be delivered directly to the ventricles of the brain and into the CSF.

Neurological Surgery, P.C. (NSPC) is a leading private neurosurgical practice in the New York region with award-winning doctors with a range of subspecialities including interventional neuroradiology, neuro-oncology, neurophysiology, epileptology (epilepsy neurology), pain management and critical care neurology. Our highly skilled neurologist and neurosurgeons are leaders in the Long Island medical community and many hold chief of neurosurgery positions in NY area hospitals.