Lung cancer is the first malignant tumor with high incidence and high mortality, meningeal metastasis is one of the serious complications, when tumor cells metastasize and invade the cerebrospinal fluid of the leptomeninges and subarachnoid space to proliferate and spread, it forms a real sense of meningeal metastasis, and patients with meningeal metastasis progress rapidly, have a high mortality rate and a very poor prognosis. If not actively treated, the survival time is only about 6~8 weeks, and progressive intracranial hypertension is one of the important reasons for the rapid progression of meningeal metastasis, high mortality and high disability rate. How to effectively control intracranial pressure in the long term is an urgent problem for clinicians to solve when treating patients.
Recently, the Cancer Center of Haici Medical Group and the Department of Neurosurgery performed Ommaya sac implantation and transventriculoperitoneal shunt for cancer patients, which can facilitate intraventricular perfusion of chemotherapy drugs and aspiration of cerebrospinal fluid to temporarily lower intracranial pressure and meet laboratory tests, and peritoneal shunt can drain excess cerebrospinal fluid from the ventricles to the abdominal cavity, which helps to reduce intracranial pressure, relieve symptoms, and improve the quality of life of patients.
The three departments of the Group's Cancer Center admitted two patients with advanced meningeal metastasis of lung adenocarcinoma, including a 36-year-old male patient with lung adenocarcinoma for 5 years, meningeal metastasis headache aggravation for 1 month, persistent headache and intermittent aggravation, taking drugs to reduce symptoms for about half an hour, accompanied by anxiety and irritability, lumbar puncture cerebral pressure of 300mmH2O, and brain MRI confirmed meningeal metastasis. Another 45-year-old female patient, lung adenocarcinoma for 1 year, continuous progress in comprehensive treatment, severe headache with seizures, lumbar puncture cerebral pressure of 260mmH2O, suspected meningeal metastasis by brain MRI, abnormal cerebrospinal fluid routine, and meningeal metastasis was confirmed in combination with clinical symptoms. Both patients showed high cerebral pressure, severe headache, short relief time, painful lumbar puncture process, low degree of cooperation, and difficulty in adhering to regular lumbar puncture sheath therapy.
Lumbar puncture and intrathecal injection are the main treatment routes, but the patient's continuous intracranial hypertension makes conventional lumbar puncture unable to meet the needs of patients and their conditions, and how to open up a simple, less painful, and sustainable access between the ventricles and the outside world has become the key to treatment. After consultation with the team of Director Cao Yufeng of the Third Department of the Cancer Center and the team of Director Kong Jun of the Department of Neurosurgery, according to the patient's condition, Ommaya sac implantation and transventriculoperitoneal shunt were performed, and the patient was transferred to the Third Department of Oncology for further treatment after the operation, and the patient's headache was reduced.
According to experts, Ommaya reservoir chemotherapy instead of intrathecal perfusion is less painful and can be carried out on time, and Ommaya reservoir chemotherapy can play a slow release role and increase the efficacy. If the patient still has symptoms of high intracranial pressure, symptoms can be relieved by adjusting the shunt valve pressure. It is supplemented with targeted therapy, systemic therapy, radiation therapy and biological therapy and other comprehensive anti-tumor therapy to better control the progression of the disease.
Peritoneal shunt is a well-established procedure in neurosurgery with fewer complications and manageable complications. This method is less invasive, easy to operate, and can reduce the pain and risk of lumbar puncture. When the cerebrospinal fluid is continuously drained, because the Ommaya sac is buried under the scalp, the chance of infection is significantly reduced compared with the external ventricular drain, and the Ommaya sac can be indwelled for life, and the cerebrospinal fluid can be punctured and drained at any time to judge the change of the condition.
A team of experts