Management of hydrocephalus in patients with leptomeningeal metastases: an ethical approach to decision-making

Journal of Neuro-oncology
Nayan LambaMarike L Broekman

Abstract

Leptomeningeal metastases (LM) are a rare, but often debilitating complication of advanced cancer that can severely impact a patient's quality-of-life. LM can result in hydrocephalus (HC) and lead to a range of neurologic sequelae, including weakness, headaches, and altered mental status. Given that patients with LM generally have quite poor prognoses, the decision of how to manage this HC remains unclear and is not only a medical, but also an ethical one. We first provide a brief overview of management options for hydrocephalus secondary to LM. We then apply general ethical principles to decision making in LM-associated hydrocephalus that can help guide physicians and patients. Management options for LM-associated hydrocephalus include shunt placement, repeated lumbar punctures, intraventricular reservoir placement, endoscopic third ventriculostomy, or pain management alone without intervention. While these options may offer symptomatic relief in the short-term, each is also associated with risks to the patient. Moreover, data on survival and quality-of-life following intervention is sparse. We propose that the pros and cons of each option should be evaluated not only from a clinical standpoint, but also within a larger framew...Continue Reading

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Citations

Sep 11, 2019·Current Opinion in Oncology·Corey M Gill, Priscilla K Brastianos
May 25, 2021·Seminars in Neurology·Mary Jane Lim-Fat, Jorg Dietrich
Oct 16, 2021·World Neurosurgery·Georgios MantziarisJason Sheehan

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