Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting. A literature search of cases of ENM related to shunt placement in patients with primary CNS tumors reported through January 2018 was performed using PubMed and Google Scholar. We identified 106 cases of ENM of primary CNS tumors related to shunt placement. The three most common tumor histologies resulting in ENM were germinoma (24%), medulloblastoma (21%), and glioblastoma (11%). Of the patients with ENM, 48% had leptomeningeal spread and 37% had brain or spinal cord metastasis. Mean survival time from shunt placement was 13 months. Ventriculoatrial-shunted cases had higher rates of widespread metastasis and shorter average survival time from shunt placement (2 months) than the average of all types of shunts. Given the known association with ENM, careful consideration should be given to shunt placement in patients with primary CNS tumors, especially germinomas, medulloblastomas, and glioblastomas. Appropriate surveillance should be instituted after shunt placement, and leptomeningeal or neural metastasis should prompt the consideration of potential ENM. When considering distal shunt options, our review suggests that ventriculoatrial shunts should be avoided if possible. For truly obstructive pathologies, the risk of ENM is a further indication to consider other treatment options such as endoscopic third ventriculostomy rather than shunt placement.
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http://dx.doi.org/10.1016/j.clineuro.2018.09.038 | DOI Listing |
J Neurosurg Case Lessons
December 2024
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Background: Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare central nervous system tumor, especially in adult females. Typically, it presents with leptomeningeal enhancements in the basal cisterns and spinal cord. However, varied radiological and pathological features can complicate the diagnosis, as the present case illustrates.
View Article and Find Full Text PDFNeurochirurgie
December 2024
Departmant of Neurosurgery, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey. Electronic address:
Introduction: Meningomyelocele is the most common congenital anomaly. It is associated with significant complications and can result in morbidity and mortality. The present study aims to identify short-term prognostic markers by investigating the characteristics of patients with meningomyelocele during hospitalization.
View Article and Find Full Text PDFJ Neurosurg Pediatr
December 2024
1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston.
Objective: Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.
View Article and Find Full Text PDFChilds Nerv Syst
December 2024
Department of Neurosurgery, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA.
Purpose: Pediatric hydrocephalus imposes a significant clinical and financial burden in developing countries. Traditional treatment by ventricular shunting in this setting suffers a high rate of shunt infection and malfunction. This study aims at assessing the efficacy and safety of endoscopic third ventriculostomy (ETV), either alone or combined with choroid plexus cauterization (CPC), for preventing shunt dependence in pediatric hydrocephalus within a healthcare setting of a tertiary hospital in Egypt.
View Article and Find Full Text PDFCureus
December 2024
Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN.
We report three cases demonstrating the efficacy and versatility of the micro-incision scleral tunnel (MIST) technique, a novel method for Ahmed glaucoma valve (AGV) tube insertion. MIST is characterized by its small incision, sutureless approach, anterior-to-posterior tunnel creation, and allograft-free design. The technique involves creating a scleral tunnel using a 1-mm crescent knife (Bleb Knife II), allowing for secure tube placement into the anterior chamber, ciliary sulcus, or vitreous cavity.
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