Carcinomatous Meningitis

Carcinomatous meningitis (CM) AKA leptomeningeal carcinomatosis is a rare complication of cancer in which cancer spreads to the membranes (meninges) surrounding the brain and spinal cord.  CM occurs in approximately 5% of people with cancer and is usually a life threatening condition.  In some cases, CA may present before the presence of systemic cancer is known.

Symptoms of Carcinomatous Meningitis

Simultaneous onset of findings may involve multiple levels of the neuraxis.  Multiple cranial nerve findings are frequent.  This may result in progressive double vision, facial pain or numbness or unilateral facial weakness.  Most frequent symptoms include headache, mental status changes, lethargy, seizures, and ataxia.  Hydrocephalus may also occur along with pain or weakness in one or more extremity.

Diagnosis of Carcinomatous Meningitis

Lumbar puncture may be performed to diagnosis carcinomatous meningitis.  Cerebrospinal fluid (CSF) is sent for cytology to look for malignant cells.  Certain tumor markers may also be found in the CSF.  Elevated protein and low glucose levels in the CSF are common abnormalities.  MRI and CAT scan of the brain and spinal cord may also be performed to diagnose CM.

Treatment for Carcinomatous Meningitis

If left untreated death usually occurs within 2 months.  Various treatment options include radiation therapy and chemotherapy.  Optimal treatment includes intrathecal delivery of chemotherapy.  This involves the injection of chemotherapeutic medication directly into the ventricles within the brain.  The ventricles are CSF–filled cavities in the center of the brain that bathes the brain and spinal cord.  Intrathecal administration of chemotherapy is usually performed via insertion of an Ommaya reservoir.  A small burr hole is used to access the brain.  A catheter is inserted into the ventricle and connected to an Ommaya reservoir that is secured under the scalp.  After the surgical procedure, the reservoir can be accessed using a small needle that pierces the scalp and reservoir for access into the ventricles.

At Princeton Neurological Surgery, Dr. Lipani is a board certified fellowship trained neurosurgeon in New Jersey and specialist in the treatment for carcinomatous meningitis, AKA leptomeningeal carcinomatosis. Dr. Lipani treats patients from around the world as well as locally from Princeton, New Brunswick, Hopewell, Pennington and communities throughout Somerset, Middlesex, Ocean, Burlington, Monmouth and Mercer Counties for all types of brain cancer. Dr. Lipani offers image guided brain surgery approaches and surgery for the placement of Ommaya reservoir. Dr. Lipani also offers the latest in noninvasive radiosurgery procedures for carcinomatous meningitis treatment, tailored to the needs of each patient. If you want the very best and latest in brain cancer treatment, or to learn about CyberKnife radiosurgery for noninvasive cancer treatment, call or email us to schedule a consultation at our offices in Hamilton, New Jersey or Bridgewater, New Jersey!

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