Neoplastic meningitis is the growth of non-functional tissue (called a neoplasm) that forms in the meninges (covering of the brain) and the subarachnoid space of the brain, and spreads through the cerebrospinal fluid.
This uncommon disease occurs in a small percentage of cancer patients, but due to increased survival rates from malignant diseases such as breast and lung cancer, there is an increased incidence in neoplastic meningitis. When diagnosed in patients with leukemia, it’s called leukemic meningitis, in patients with lymphoma it’s known as lymphomatous meningitis, and if it is diagnosed in patients with solid tumors such as breast, lung or skin cancer it’s called carcinomatous meningitis.
Causes and Symptoms of Neoplastic Meningitis
Since the cerebrospinal fluid is ferrying the cancer cells to the central nervous system—consisting of the brain, spinal nerve roots, and cranial nerves—most of the symptoms relate to cerebral, spinal and cranial nerve dysfunction:
Neoplastic meningitis symptoms in the spinal column can lead to:
pain in the neck or back
hemiparesis (paralysis on one side of the body)
Cranial nerve dysfunction symptoms, which may be due to increased intracranial pressure, can create cranial nerve palsy:
vision problems such as double vision or vision loss
tinnitus (ringing in the ears) or hearing loss
facial numbness (if the trigeminal nerve is affected)
confusion or mental impairment
nausea and/or vomiting
How Is Neoplastic Meningitis Diagnosed?
An MRi (magnetic resonance imaging) with enhanced contrast dye such as gadolinium-based, may show the presence of neoplastic meningitis. A lumbar puncture, or spinal tap, is used to draw out a portion of cerebrospinal fluid (CSF). Although the needle is inserted close to where the neoplasm is expected to be, often several draws are needed to increase the likelihood of verifying whether cancer cells are present in the CSF. A CSF flow study will also show blockages or collections of fluid.
State-of-the-Art Treatments for Neoplastic Meningitis at NSPC
Neoplastic meningitis treatments are considered palliative, with an emphasis on limiting symptoms such as neurologic deterioration and extending quality of life. Neurological Surgery, P.C. (NSPC) is at the forefront of advanced brain cancer treatments and participates in clinical trials to help in the search for cures to these life-changing cancers.
The blood-brain barrier hampers toxins, viruses and bacteria from permeating the brain’s tissues. However, this same blood-brain barrier also hinders most cancer-fighting drugs from reaching these tissues. Administering intrathecal cancer drugs directly into the cerebrospinal fluid (CSF), helps bypass the blood-brain barrier.
Chemotherapy can be delivered directly to the CSF via a lumbar puncture or Ommaya reservoir. A neurosurgeon places an Ommaya reservoir—a small bubble-shaped basin created just under the scalp with an attached tube that drains directly into one of the ventricles of the brain—during a craniotomy to allow chemotherapy to easily reach the meninges.
NSPC’s skilled neurosurgeons use image-guided stereotactic radiosurgery, such as Gamma Knife® or CyberKnife®, as an alternative to whole brain radiation. Stereotactic radiotherapy can precisely target tumors or other malignant growths, while preserving the nearby tissue. The treatment is bloodless and often completed in one single session.
NSPC consists of a multidisciplinary team of board-certified neurosurgeons and convenient offices on Long Island and the NYC area. NSPC’s award-winning doctors are leaders in the New York medical community, and many serve as chiefs of neurosurgery in NY hospitals. These expert physicians specialize in a range of neurosurgical subspecialties and related fields such as interventional neuroradiology, neuro-oncology, epileptology (epilepsy neurology), neurophysiology, critical neurology and pain management.