{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:00:06Z","timestamp":1785214806305,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leptomeningeal carcinomatosis (LC) complicated by hydrocephalus carries a poor prognosis. Intracerebrospinal fluid (intra-CSF) chemotherapy is a main treatment, but the optimal route of administration remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 36 LC patients with hydrocephalus who received intra-CSF methotrexate via Ommaya reservoir (OR,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15) or lumbar puncture (LP,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f21). Efficacy, safety, and overall survival (OS) were compared. Prognostic factors were analyzed using Cox regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The OR group achieved significantly higher overall response rate (86.7% vs. 47.6%,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.016) and clinical response rate (100% vs. 52.4%,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.002), alongside superior intracranial pressure relief (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.042). Rates of complications and chemotherapy-related toxicities were comparable in both arms. Median overall survival (OS) was 54.7\u202fweeks for OR patients versus 44.1\u202fweeks for LP patients, without statistically significant intergroup difference (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.53). After adjusting for primary tumor subtypes in multivariate Cox regression, extraneural metastasis remained an independent adverse prognostic factor (HR\u202f=\u202f4.251,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.009), whereas targeted therapy independently predicted prolonged OS (HR\u202f=\u202f0.101,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). Treatment response lost independent predictive significance after full adjustment (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.055). Tumor subtype showed no significant correlation with survival outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In LC patients with hydrocephalus, intra-CSF methotrexate via OR does not prolong OS but yields superior symptom relief and intracranial pressure control without increased adverse events. Concurrent targeted therapy is independently linked to favorable long-term survival; extraneural metastasis confers higher mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1848001","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:25:37Z","timestamp":1785212737000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of intracerebrospinal fluid methotrexate by Ommaya reservoir versus lumbar puncture in leptomeningeal carcinomatosis with hydrocephalus: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Kun","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junying","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Bu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]},{"name":"Institute of Cardiocerebrovascular Disease","place":["Shijiazhuang, Hebei, China"]},{"name":"Neurological Laboratory of Hebei Province","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1053\/j.seminoncol.2006.04.016","article-title":"Neoplastic meningitis from systemic malignancies: diagnosis, prognosis and treatment","volume":"33","author":"Jaeckle","year":"2006","journal-title":"Semin 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