{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T02:03:12Z","timestamp":1788573792067,"version":"build-2803163510"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Leptomeningeal metastasis (LM) is associated with altered CSF flow dynamics in 50%\u201370% of patients. Approximately 1%\u20135% of patients develop symptomatic LM-associated hydrocephalus (LM-H), which adversely impacts quality of life (QOL), functional status, and overall survival (OS). There is equipoise for CSF diversion procedures in LM-H. This systematic review and meta-analysis aimed to assess the effect of CSF diversion on OS and QOL in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This systematic review was conducted according to the PRISMA guidelines. PubMed\/Medline, Embase, Web of Science, and Scopus were searched for articles that evaluated the role of CSF diversion for LM-H due to systemic cancer in adult patients. A meta-analysis was conducted using random effects models, with mean differences and 95% CIs reported. Bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Ten eligible studies with a total of 494 patients were included. Two studies reported multivariate HRs for median OS, suggesting no significant effect of shunting on OS (pooled HR 0.42, 95% CI 0.09\u20131.94, p = 0.27). A difference between preoperative and postoperative Karnofsky Performance Status of mean 17.6 points (95% CI 10.44\u201324.68, p &lt; 0.0001) was calculated from 4 studies. Across all studies, a symptomatic improvement rate of 67%\u2013100% was observed, with high rates of improvement for headaches and nausea and lower rates for cranial nerve palsies. Complication rates across 9 studies ranged from 0% to 21.1%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Based on the present findings, shunting does not improve OS but does relieve symptoms, suggesting that individuals who exhibit certain symptoms should be considered for CSF diversion. The present findings prompt the generation of a standardized decision-making tool and a critical analysis of the individual patient risk-benefit ratio. Implementation of these will optimize surgical management of LM-H patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.5.focus23195","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T07:18:57Z","timestamp":1690874337000},"page":"E16","source":"Crossref","is-referenced-by-count":13,"title":["Survival and quality of life after CSF diversion in adult patients with leptomeningeal metastasis\u2013associated hydrocephalus: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"55","author":[{"given":"Jasneet","family":"Dhaliwal","sequence":"first","affiliation":[{"name":"UCL Medical School, University College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Ruiz-Perez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Center for Research and Training in Neurosurgery, Hospital Universitario de la Samaritana, Bogot\u00e1, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Mihaela-Vasilica","sequence":"additional","affiliation":[{"name":"UCL Medical School, University College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aswin","family":"Chari","sequence":"additional","affiliation":[{"name":"Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom;"},{"name":"Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom;"},{"name":"Developmental Neuroscience, Institute of Child Health, University College London, London, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciaran Scott","family":"Hill","sequence":"additional","affiliation":[{"name":"Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom;"},{"name":"UCL Cancer Institute, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Thorne","sequence":"additional","affiliation":[{"name":"Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Cerebrospinal Fluid and Subarachnoid Space Volume 2: Pathology and Disorders","article-title":"CSF and disease: brain and leptomeningeal metastases","author":"Faiver L","year":"2023","unstructured":"Faiver L, Gutgsell O, Umemura Y. CSF and disease: brain and leptomeningeal metastases. In: Tubbs RS, Joe Iwanaga, Rizk E, D\u2019Antoni A, Dumont AS, eds.Cerebrospinal Fluid and Subarachnoid Space Volume 2: Pathology and Disorders. Elsevier; 2023."},{"issue":"1","key":"b2","series-title":"Palliat Med","first-page":"93","article-title":"Palliative lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus: a case series","volume":"31","author":"Yamashiro S","year":"2017","unstructured":"Yamashiro S, Hitoshi Y, Tajiri S,  Palliative lumboperitoneal shunt for leptomeningeal metastasis-related hydrocephalus: a case series. Palliat Med. 2017;31(1):93\u201396.27188875"},{"issue":"4","key":"b3","series-title":"Curr Cancer Ther Rev","first-page":"319","article-title":"Leptomeningeal metastasis: challenges in diagnosis and treatment","volume":"7","author":"Leal T","year":"2011","unstructured":"Leal T, Chang JE, Mehta M, Robins HI. Leptomeningeal metastasis: challenges in diagnosis and treatment. 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