Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim,Fares; Critchlow,Jonathan  F.; Kasper,Ekkehard  M.

doi:10.3892/mco.2015.627

November-2015 Volume 3 Issue 6

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November-2015 Volume 3 Issue 6

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Article

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Authors:
- Fares Nigim
- Jonathan F. Critchlow
- Ekkehard M. Kasper
View Affiliations / Copyright

Affiliations: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Pages: 1381-1386
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Published online on: August 31, 2015

https://doi.org/10.3892/mco.2015.627
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Abstract

Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first‑time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t‑test and Kaplan‑Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow‑up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow‑up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3‑month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day‑76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.

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1	Kehrli P: Epidemiology of brain metastases. Neurochirurgie. 45:357–363. 1999.((In French)). PubMed/NCBI
2	Fidler IJ: The role of the organ microenvironment in brain metastasis. Semin Cancer Biol. 21:107–112. 2011. View Article : Google Scholar : PubMed/NCBI
3	Herrlinger U, Förschler H, Küker W, Meyermann R, Bamberg M, Dichgans J and Weller M: Leptomeningeal metastasis: Survival and prognostic factors in 155 patients. J Neurol Sci. 223:167–178. 2004. View Article : Google Scholar : PubMed/NCBI
4	Miralbell R, Tolnay M, Bieri S, Probst A, Sappino AP, Berchtold W, Pepper MS and Pizzolato G: Pediatric medulloblastoma: Prognostic value of p53, bcl-2, Mib-1 and microvessel density. J Neurooncol. 45:103–110. 1999. View Article : Google Scholar : PubMed/NCBI
5	Oechsle K, Lange-Brock V, Kruell A, Bokemeyer C and de Wit M: Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: A retrospective analysis. J Cancer Res Clin Oncol. 136:1729–1735. 2010. View Article : Google Scholar : PubMed/NCBI
6	Omuro AM, Lallana EC, Bilsky MH and DeAngelis LM: Ventriculoperitoneal shunt in patients with leptomeningeal metastasis. Neurology. 64:1625–1627. 2005. View Article : Google Scholar : PubMed/NCBI
7	Taillibert S and Hildebrand J: Treatment of central nervous system metastases: Parenchymal, epidural and leptomeningeal. Curr Opin Oncol. 18:637–643. 2006. View Article : Google Scholar : PubMed/NCBI
8	Kaplan JG, DeSouza TG, Farkash A, Shafran B, Pack D, Rehman F, Fuks J and Portenoy R: Leptomeningeal metastases: Comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias. J Neurooncol. 9:225–229. 1990. View Article : Google Scholar : PubMed/NCBI
9	Pedersen PH, Rucklidge GJ, Mørk SJ, Terzis AJ, Engebraaten O, Lund-Johansen M, Backlund EO, Laerum OD and Bjerkvig R: Leptomeningeal tissue: A barrier against brain tumor cell invasion. J Natl Cancer Inst. 86:1593–1599. 1994. View Article : Google Scholar : PubMed/NCBI
10	Shapiro WR, Posner JB, Ushio Y, Chemik NL and Young DF: Treatment of meningeal neoplasms. Cancer Treat Rep. 61:733–743. 1977.PubMed/NCBI
11	Wasserstrom WR, Glass JP and Posner JB: Diagnosis and treatment of leptomeningeal metastases from solid tumors: Experience with 90 patients. Cancer. 49:759–772. 1982. View Article : Google Scholar : PubMed/NCBI
12	Chen CC, Kasper E and Warnke P: Palliative stereotactic-endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from cerebral metastasis. Surg Neurol Int. 2:762011. View Article : Google Scholar : PubMed/NCBI
13	Glantz MJ, Jaeckle KA, Chamberlain MC, Phuphanich S, Recht L, Swinnen LJ, Maria B, LaFollette S, Schumann GB, Cole BF, et al: A randomized controlled trial comparing intrathecal sustained-release cytarabine (DepoCyt) to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors. Clin Cancer Res. 5:3394–3402. 1999.PubMed/NCBI
14	Gonda DD, Kim TE, Warnke PC, Kasper EM, Carter BS and Chen CC: Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int. 3:972012. View Article : Google Scholar : PubMed/NCBI
15	Schiff D, Kline C, Meltzer H and Auger J: Palliative ventriculoperitoneal shunt in a pediatric patient with recurrent metastatic medulloblastoma. J Palliat Med. 12:391–393. 2009. View Article : Google Scholar : PubMed/NCBI
16	Inamasu J, Nakamura Y, Saito R, Kuroshima Y, Mayanagi K, Orii M and Ichikizaki K: Postoperative communicating hydrocephalus in patients with supratentorial malignant glioma. Clin Neurol Neurosurg. 106:9–15. 2003. View Article : Google Scholar : PubMed/NCBI
17	Lokich J, Levine H and Nasser I: Malignancy-related hydrocephalus: Clinical features and results of ventricular peritoneal shunt procedure in three patients. Am J Clin Oncol. 21:366–368. 1998. View Article : Google Scholar : PubMed/NCBI
18	Lee SH, Kong DS, Seol HJ, Nam DH and Lee JI: Ventriculoperitoneal shunt for hydrocephalus caused by central nervous system metastasis. J Neurooncol. 104:545–551. 2011. View Article : Google Scholar : PubMed/NCBI
19	Handler MH and Callahan B: Laparoscopic placement of distal ventriculoperitoneal shunt catheters. J Neurosurg Pediatr. 2:282–285. 2008. View Article : Google Scholar : PubMed/NCBI
20	Naftel RP, Argo JL, Shannon CN, Taylor TH, Tubbs RS, Clements RH and Harrigan MR: Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: Review of 810 consecutive cases. J Neurosurg. 115:151–158. 2011. View Article : Google Scholar : PubMed/NCBI
21	Roth J, Sagie B, Szold A and Elran H: Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surg Neurol. 68:177–184. 2007. View Article : Google Scholar : PubMed/NCBI
22	Brust JC, Moiel RH and Rosenberg RN: Glial tumor metastases through a ventriculo-pleural shunt. Resultant massive pleural effusion. Arch Neurol. 18:649–653. 1968. View Article : Google Scholar : PubMed/NCBI
23	Duffner PK and Cohen ME: Extraneural metastases in childhood brain tumors. Ann Neurol. 10:261–265. 1981. View Article : Google Scholar : PubMed/NCBI
24	Eralp Y, Saip P, Aydin Z, Berkman S and Topuz E: Leptomeningeal dissemination of ovarian carcinoma through a ventriculoperitoneal shunt. Gynecol Oncol. 108:248–250. 2008. View Article : Google Scholar : PubMed/NCBI
25	Glantz MJ, Cole BF, Recht L, Akerley W, Mills P, Saris S, Hochberg F, Calabresi P and Egorin MJ: High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: Is intrathecal chemotherapy necessary? J Clin Oncol. 16:1561–1567. 1998.PubMed/NCBI
26	Hoffman HJ, Hendrick EB and Humphreys RP: Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma. J Neurosurg. 44:562–566. 1976. View Article : Google Scholar : PubMed/NCBI
27	Hoffman HJ and Duffner PK: Extraneural metastases of central nervous system tumors. Cancer. 56(Suppl 7): 1778–1782. 1985. View Article : Google Scholar : PubMed/NCBI
28	Ingold B, Moschopulos M, Hutter G, Seeger H, Röthlisberger B, Landolt H, Yonekawa Y, Jochum W and Heppner FL: Abdominal seeding of an atypical teratoid/rhabdoid tumor of the pineal gland along a ventriculoperitoneal shunt catheter. Acta Neuropathol. 111:56–59. 2006. View Article : Google Scholar : PubMed/NCBI
29	Korones DN, Meyers SP, Rubio A, Torres C and Constine LSA: A 4-year-old girl with a ventriculoperitoneal shunt metastasis of a central nervous system atypical teratoid/rhabdoid tumor. Med Pediatr Oncol. 32:389–391. 1999. View Article : Google Scholar : PubMed/NCBI
30	Belongia M and Jogal S: Extraneural metastasis of a nongerminomatous germ cell tumor of the central nervous system in a pediatric patient with a ventriculoperitoneal shunt: A case report and review of the literature. J Pediatr Hematol Oncol. 34:e12–e16. 2012. View Article : Google Scholar : PubMed/NCBI
31	Oberbauer RW, Tritthart H, Ascher PW, Walter GF and Becker H: Shunt metastases in posterior fossa tumors. Neuropadiatrie. 10:296–300. 1979. View Article : Google Scholar : PubMed/NCBI
32	Paul MJ, Summers Y, Calvert AH, Rustin G, Brampton MH, Thatcher N and Middleton MR: Effect of temozolomide on central nervous system relapse in patients with advanced melanoma. Melanoma Res. 12:175–178. 2002. View Article : Google Scholar : PubMed/NCBI
33	Rickert CH: Extraneural metastases of paediatric brain tumours. Acta Neuropathol. 105:309–327. 2003.PubMed/NCBI
34	Rubery ED and Wheeler TK: Metastases outside the central nervous system from a presumed pineal germinoma. Case report. J Neurosurg. 53:562–565. 1980.PubMed/NCBI
35	Russell DS and Rubinstein LJ: Pathology of tumors of the nervous system. (4th). (Arnold, London). 206–207. 1977.
36	Sakata K, Yamada H, Sakai N, Hosono Y, Kawasako T and Sasaoka I: Extraneural metastasis of pineal tumor. Surg Neurol. 3:49–54. 1975.PubMed/NCBI
37	Wakamatsu T, Matsuo T, Kawano S, Teramoto S and Matsumura H: Glioblastoma with extracranial metastasis through ventriculopleural shunt. Case report. J Neurosurg. 34:697–701. 1971.PubMed/NCBI
38	Triolo PJ and Schulz EE: Metastatic germinoma (pinealoma) via a ventriculoperitoneal shunt. AJR Am J Roentgenol. 135:854–855. 1980. View Article : Google Scholar : PubMed/NCBI
39	Han YP, Zhao Y, He XG and Ma J: Peritoneal metastasis of third ventricular atypical teratoid/rhabdoid tumor after VP shunt implantation for unexplained hydrocephalus. World J Pediatr. 8:367–370. 2012. View Article : Google Scholar : PubMed/NCBI
40	Berger MS, Baumeister B, Geyer JR, Milstein J, Kanev PM and LeRoux PD: The risks of metastases from shunting in children with primary central nervous system tumors. J Neurosurg. 74:872–877. 1991. View Article : Google Scholar : PubMed/NCBI
41	Berg SL and Chamberlain MC: Systemic chemotherapy, intrathecal chemotherapy, and symptom management in the treatment of leptomeningeal metastasis. Curr Oncol Rep. 5:29–40. 2003. View Article : Google Scholar : PubMed/NCBI
42	Boogerd W, van den Bent MJ, Koehler PJ, Heimans JJ, van der Sande JJ, Aaronson NK, Hart AA, Benraadt J and Vecht CHJ: The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: A randomised study. Eur J Cancer. 40:2726–2733. 2004. View Article : Google Scholar : PubMed/NCBI
43	DeAngelis LM and Boutros D: Leptomeningeal metastasis. Cancer Invest. 23:145–154. 2005. View Article : Google Scholar : PubMed/NCBI
44	Lobotesis K, U-King-Im JM, Cross JJ, Gillard JH and Antoun NM: Gliomatosis peritonei associated with a ventriculo-peritoneal shunt. Clin Radiol. 64:95–99. 2009. View Article : Google Scholar : PubMed/NCBI
45	Zemack G and Romner B: Seven years of clinical experience with the programmable Codman Hakim valve: A retrospective study of 583 patients. J Neurosurg. 92:941–948. 2000. View Article : Google Scholar : PubMed/NCBI
46	Lassman AB, Abrey LE, Shah GD, Panageas KS, Begemann M, Malkin MG and Raizer JJ: Systemic high-dose intravenous methotrexate for central nervous system metastases. J Neurooncol. 78:255–260. 2006. View Article : Google Scholar : PubMed/NCBI
47	Pentheroudakis G and Pavlidis N: Management of leptomeningeal malignancy. Expert Opin Pharmacother. 6:1115–1125. 2005. View Article : Google Scholar : PubMed/NCBI
48	Farahmand D, Hilmarsson H, Högfeldt M and Tisell M: Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry. 80:1248–1253. 2009. View Article : Google Scholar : PubMed/NCBI
49	Hoh BL, Lang SS, Ortiz MV, Chi YY, Lewis SB and Pincus DW: Lower incidence of reoperation with longer shunt survival with adult ventriculoperitoneal shunts placed for hemorrhage-related hydrocephalus. Neurosurgery. 63:70–74. 2008. View Article : Google Scholar : PubMed/NCBI
50	Reddy GK, Bollam P, Caldito G, Willis B, Guthikonda B and Nanda A: Ventriculoperitoneal shunt complications in hydrocephalus patients with intracranial tumors: An analysis of relevant risk factors. J Neurooncol. 103:333–342. 2011. View Article : Google Scholar : PubMed/NCBI
51	Lin N, Dunn IF, Glantz M, Allison DL, Jensen R, Johnson MD, Friedlander RM and Kesari S: Benefit of ventriculoperitoneal cerebrospinal fluid shunting and intrathecal chemotherapy in neoplastic meningitis: A retrospective, case-controlled study. J Neurosurg. 115:730–736. 2011. View Article : Google Scholar : PubMed/NCBI