Neoplastic meningitis is the spread of tumor cells to the meninges. Treatment involves surgery, chemotherapy, and radiation therapy. The prognosis for patients is better the earlier neoplastic meningitis is detected. Overall, however, the prognosis is poor because a primary cancer is usually present as well.
Meningeosis neoplastica is the spread of tumor cells into the soft meninges. The meninges play an important role in metabolism and surround the brain. They protect the brain from external influences such as temperature fluctuations.
The meninges merge with the spinal meninges and are connected to the cerebrospinal fluid. This is how tumor cells enter the meninges, since meningeosis neoplastica usually results from a pre-existing cancer. Existing tumor cells spread throughout the body via the bloodstream or lymphatic system and thus reach the meninges.
The meninges surround the brain in several layers inside the skull. @ bilderzwerg / AdobeStock
About 3–5% of cancer patients develop meningeosis neoplastica. The terms used vary depending on the origin of the cancer cells:
However, the origin of the tumor cells has no influence on the symptoms or the course of the disease.
The symptoms of meningeosis neoplastica depend on both the extent of the disease and its location:
Due to increased intracranial pressure and possible damage to the spinal cord, some patients experience the following symptoms:
In the early stages, meningeosis neoplastica is often asymptomatic. Initial mild signs of metastasis are usually not taken seriously or correctly interpreted.
The first test performed when meningeosis neoplastica is suspected is an MRI of the skull and spine in the neuroradiology department. If possible, a contrast agent is used during the procedure, as the brain structures cannot be clearly visualized otherwise. The MRI images reveal the extent of the tumor and exactly which structures are affected. If an MRI cannot be performed, doctors will resort to a CT scan.
If the MRI findings are abnormal, a lumbar puncture is performed to confirm the diagnosis. During this procedure, specialists withdraw cerebrospinal fluid from the lumbar spine and then examine it for the presence of tumor cells.
If the initial results are negative, up to two additional tests may be recommended. If doctors are still unable to detect cancer cells, a biopsy can provide further insight.
Treating meningeosis neoplastica is a challenge. The approach depends on the exact extent of the cancer’s spread. If metastases are present in other parts of the body, systemic chemotherapy is administered.
Since most medications cannot cross the blood-brain barrier, they generally have no beneficial effect on neoplastic meningeosis. The blood-brain barrier is the boundary between the blood and the central nervous system. Only certain substances can cross into the brain through the cells lining the outside of the blood vessel walls. This protects the brain from harmful substances, pathogens, and toxins.
Since oral medications are ineffective, intrathecal chemotherapy is used to combat tumor cells in the meninges. In this procedure, the active ingredients are injected directly into the cerebrospinal fluid either via a lumbar puncture or through a catheter. This therapy has fewer side effects, as the dose used is usually low.
For larger brain and spinal cord tumors, surgical removal followed by chemotherapy and/or radiation therapy is performed whenever possible.
To effectively treat multiple smaller tumors in the brain and on the meninges, the affected areas are treated with radiation. Patients also receive radiation as part of palliative care to relieve pain.
When treating neoplastic meningeosis, doctors and patients always weigh the costs and benefits of the approach. The prognosis is rather poor, with a 1-year survival rate of 5–25%. Even if the cancer cells in the brain are successfully treated, other tumors in the body can severely weaken the patient and ultimately lead to death. The average survival time with a good prognosis is about seven months.
As a form of cancer, neoplastic meningeosis falls within the field of oncology. Most patients are already under oncological care due to the primary tumor that caused the condition. You should always discuss any new symptoms with your treating oncologist to detect metastases early.
For diagnosis and treatment, specialists typically consult a neurologist as well. This specialist is highly familiar with the structures of the brain and their metabolism. Working closely with the treating oncologist, the neurologist coordinates the treatment of meningeosis neoplastica and monitors its progression.
A neuroradiologist performs diagnostic imaging using CT scans and administers radiation therapy. This specialist is trained in the radiation treatment of brain tissue and is therefore also knowledgeable about the structures of this organ. At the same time, they know the correct radiation doses and can administer the treatment based on the imaging results.
The greatest risk factor for the development of neoplastic meningitis is the presence of another cancer. If metastases form in the meninges, time is of the essence: the sooner doctors detect metastases in the meninges, the sooner they can be treated.
However, even if specialists manage to bring neoplastic meningitis under control, the prognosis remains poor due to the primary cancer.
https://www.aerzteblatt.de/archiv/52868/Meningeosis-neoplastica
https://de.wikipedia.org/wiki/Meningeosis_neoplastica
https://www.amboss.com/de/wissen/Meningeosis_neoplastica
