{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:10:12Z","timestamp":1785247812408,"version":"3.55.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Neoplastic meningitis (NM) is a debilitating and increasingly frequent neurological complication of cancer characterized by infiltration of tumor cells into the leptomeninges and the subarachnoid space. Although NM is rarely curable, combined intrathecal chemotherapy and focal radiation can improve disease-related symptoms and survival. Hydrocephalus occurs in a significant proportion of patients, is associated with poor prognosis and reduced quality of life, and usually precludes the use of intrathecal therapy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Since January of 2005, the authors have used a combined treatment approach for patients with both NM and hydrocephalus that employs a subcutaneously placed reservoir connected in series to an on\/off valve and a ventriculoperitoneal shunt for both diversion of CSF and injection of intrathecal chemotherapy. They conducted a retrospective, case-controlled study from 2 independent institutions to review their experience.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Twenty-four patients with NM and hydrocephalus underwent placement of a CSF reservoir-on\/off valve-ventriculoperitoneal shunt (RO-VPS) construct. There was no perioperative mortality, and there were only 2 minor complications. One shunt failure and no shunt-associated infections were observed over a median of 28 weeks of follow-up. Symptomatic improvement and improved performance status were seen in 20 patients (83.3%) and were sustained over 6 months. Eighteen patients received intraventricular chemotherapy without unexpected toxicity, and cytological responses were found in 11 patients (61.1%). Median progression-free and overall survival was 14 and 31 weeks, respectively. Compared with a contemporaneous comparison group of 24 demographically matched patients with NM who underwent CSF reservoir placement only, those who received RO-VPS constructs (p = 0.02) and had primary diagnosis of breast cancer (p = 0.04) had significant advantage in overall survival.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A combined RO-VPS system is safe and practical to install, results in symptomatic improvement in most patients, and allows uncomplicated and effective administration of intrathecal chemotherapy in patients with NM. Cerebrospinal fluid diversion surgery should be considered in NM patients in conjunction with intrathecal and systemic treatments.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.5.jns101768","type":"journal-article","created":{"date-parts":[[2011,7,1]],"date-time":"2011-07-01T13:59:37Z","timestamp":1309528777000},"page":"730-736","source":"Crossref","is-referenced-by-count":54,"title":["Benefit of ventriculoperitoneal cerebrospinal fluid shunting and intrathecal chemotherapy in neoplastic meningitis: a retrospective, case-controlled study"],"prefix":"10.3171","volume":"115","author":[{"given":"Ning","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital;"},{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital;"},{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Glantz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana L.","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital;"},{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Friedlander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital;"},{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Kesari","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Moores Cancer Center, University of California, San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101768","series-title":"J Neurosurg","first-page":"872","article-title":"The risks of metastases from shunting in children with primary central nervous system tumors","volume":"74","author":"Berger","year":"1991"},{"key":"b2-jns101768","series-title":"J Clin Oncol","first-page":"3281","article-title":"Diagnosing leptomeningeal carcinomatosis with negative CSF cytology in advanced prostate cancer","volume":"26","author":"Bernstein","year":"2008"},{"key":"b3-jns101768","series-title":"Cancer","first-page":"1756","article-title":"Leptomeningeal metastases from solid tumors: a comparison of two prospective series treated with and without intra-cerebrospinal fluid chemotherapy","volume":"82","author":"Bokstein","year":"1998"},{"key":"b4-jns101768","series-title":"Eur J Cancer","first-page":"2726","article-title":"The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomised study","volume":"40","author":"Boogerd","year":"2004"},{"key":"b5-jns101768","series-title":"J Natl Compr Canc Netw","first-page":"352","article-title":"Central nervous system cancers","volume":"9","author":"Brem","year":"2011"},{"key":"b6-jns101768","series-title":"Cancer","first-page":"381","article-title":"Leptomeningeal carcinomatosis: prognostic implications of clinical and cerebrospinal fluid features","volume":"115","author":"Bruna","year":"2009"},{"key":"b7-jns101768","series-title":"Cancer Treat Res","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/0-387-24199-X_3","article-title":"Leptomeningeal metastases from solid tumors (meningeal carcinomatosis)","volume":"125","author":"Bruno","year":"2005"},{"key":"b8-jns101768","series-title":"Neurology","first-page":"783","article-title":"Ventriculoperitoneal shunt in patients with leptomeningeal metastasis","volume":"66","author":"Chamberlain","year":"2006"},{"key":"b9-jns101768","series-title":"J Natl Compr Canc Netw","first-page":"693","article-title":"Leptomeningeal metastases: current concepts and management guidelines","volume":"3","author":"Chowdhary","year":"2005"},{"key":"b10-jns101768","series-title":"Cancer Invest","first-page":"145","article-title":"Leptomeningeal metastasis","volume":"23","author":"DeAngelis","year":"2005"},{"key":"b11-jns101768","series-title":"Neurologic Complications of Cancer","first-page":"240","article-title":"Leptomeningeal metastases","year":"2008"},{"key":"b12-jns101768","series-title":"Curr Treat Options Neurol","first-page":"283","article-title":"Leptomeningeal neoplasms","volume":"9","author":"Drappatz","year":"2007"},{"key":"b13-jns101768","series-title":"Cancer","first-page":"2919","article-title":"Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status","volume":"75","author":"Glantz","year":"1995"},{"key":"b14-jns101768","series-title":"Clin Cancer Res","first-page":"3394","article-title":"A randomized controlled trial comparing intrathecal sustained-release cytarabine (Depo-Cyt) to intrathecal methotrexate in patients with neoplastic meningitis from solid tumors","volume":"5","author":"Glantz","year":"1999"},{"key":"b15-jns101768","series-title":"J Clin Oncol","first-page":"561","article-title":"Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. 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