J Korean Neurosurg Soc.  2016 Nov;59(6):570-576. 10.3340/jkns.2016.59.6.570.

Retrospective Analysis of Cerebrospinal Fluid Profiles in 228 Patients with Leptomeningeal Carcinomatosis : Differences According to the Sampling Site, Symptoms, and Systemic Factors

• Shim Y
• Gwak HS
• Kim S
• Joo J
• Shin SH
• Yoo H

• KMID: 2417338
• DOI: http://doi.org/10.3340/jkns.2016.59.6.570

Abstract

OBJECTIVE
Elevated cell counts and protein levels in cerebrospinal fluid (CSF) result from disease activity in patients with leptomeningeal carcinomatosis (LMC). Previous studies evaluated the use of CSF profiles to monitor a treatment response or predict prognosis. CSF profiles vary, however, according to the sampling site and the patient's systemic condition. We compared lumbar and ventricular CSF profiles collected before intraventricular chemotherapy for LMC and evaluated the association of these profiles with patients' systemic factors and LMC disease activity.
METHODS
CSF profiles were retrospectively collected from 228 patients who underwent Ommaya reservoir insertion for intraventricular chemotherapy after a diagnosis of LMC. Lumbar samples taken via lumbar puncture were used for the diagnosis, and ventricular samples were obtained later at the time of Ommaya reservoir insertion. LMC disease activity was defined as the presence of LMC-related symptoms such as increased intracranial pressure, hydrocephalus, cranial neuropathy, and cauda equina syndrome.
RESULTS
Cell counts (median : 8 vs. 1 cells/mL) and protein levels (median : 68 vs. 17 mg/dL) significantly higher in lumbar CSF than in ventricular CSF (p<0.001). Among the evaluated systemic factors, concomitant brain metastasis and previous radiation were significantly correlated with higher protein levels in the lumbar CSF (p=0.01 and <0.001, respectively). Among the LMC disease activity, patients presenting with hydrocephalus or cauda equina syndrome showed higher lumbar CSF protein level compared with that in patients without those symptoms (p=0.049 and p<0.001, respectively). The lumbar CSF cell count was significantly lower in patients with cranial neuropathy (p=0.046). The ventricular CSF cell counts and protein levels showed no correlation with LMC symptoms. Carcinoembryonic antigen (CEA), which was measured from ventricular CSF after the diagnosis in 109 patients, showed a significant association with the presence of hydrocephalus (p=0.01).
CONCLUSION
The protein level in lumbar CSF indicated the localized disease activity of hydrocephalus and cauda equina syndrome. In the ventricular CSF, only the CEA level reflected the presence of hydrocephalus. We suggest using more specific biomarkers for the evaluation of ventricular CSF to monitor disease activity and treatment response.

Keyword

Cerebrospinal fluid; Leptomeningeal carcinomatosis; Lumbar; Ventricular

MeSH Terms

Biomarkers
Brain
Carcinoembryonic Antigen
Cell Count
Cerebrospinal Fluid*
Cranial Nerve Diseases
Diagnosis
Drug Therapy
Humans
Hydrocephalus
Intracranial Pressure
Meningeal Carcinomatosis*
Neoplasm Metastasis
Polyradiculopathy
Prognosis
Retrospective Studies*
Spinal Puncture
Biomarkers
Carcinoembryonic Antigen

Figure

• 

  Fig. 1 Distribution of CSF profiles of total cell count (A and B) and protein level (C and D) according to the different sampling site of lumbar (A and C) and ventricular (B and D). CSF : cerebrospinal fluid.

• 

  Fig. 2 Comparison of CSF cell count (A) and protein level (B) between lumbar and ventricular samples shows a significant difference (p<0.001, both A and B). The bold line is the median value, and the box represents quartile values. Individual solid lines connect lumbar and ventricular CSF profiles of individual patients in terms of cell count (C) and protein level (D). CSF : cerebrospinal fluid.

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