Treatment > Leptomeningeal Diseases

Meeting Abstract

Leptomeningeal gliomatosis: An uncommon complication in patients with gliomas

L. A. W. Henriques, J. Raizer

Memorial Sloan-Kettering Cancer Center, New York, NY

[Background & Methods.] Leptomeningeal Gliomatosis (LG) is an rare complication of gliomas.
Limited data exists on its clinical course, radiographic, spinal fluid abnormalities and outcome.
We reviewed the neurology database (1995-2002) for pts with gliomas who developed LG.
Clinical presentation, time to development, diagnostic workup, and outcome was assessed.

Results. 14 men and 6 women were diagnosed with LG.
Median age was 50.5 years (22-74).
Presenting symptoms were cognitive decline (11 pts), gait difficulty (7 pts), back pain (5 pts), cranial neuropathy (2 pts).
2 pts were asymptomatic.
Primary tumor was supratentorial in 15 pts and infratentorial or spinal cord in 5.
Primary tumor was in the temporal lobe in 8 pts, frontal in 5, parietal in 4.
More than one lobe was involved in 3 pts.
Non-lobar tumors included cerebellum (3 pts), diencephalon (2 pts), brainstem (1 pt), conus medullaris (2 pts).
Primary histology was GBM (11 pts), AA (6 pts), JPA (1 pt), low grade oligodendroglioma and astrocytoma (1 pt each).
All pts were diagnosed with LG by MRI: 9 with intracranial disease, 2 with spinal disease, 9 with both.
5 pts had hydrocephalus on MRI at presentation, 4 developed hydrocephalus after diagnosis.
10 LP's were performed in 6 pts: 2 specimens had positive cytology, median protein was 373 mg/dl (33-2334), RBC was between 2-4555 (median 35), WBC was between 1-15 (median 4), glucose was normal.
1 pt with low-grade glioma is responding to treatment, 4 pts had a brief response, 13 pts never responded to treatment, no information is available on 2 pts.
Median time from glioma diagnosis to LG was 21.4 (0-256) weeks (wks) in malignant gliomas and 280 (203-336) wks in low grade.
15 pts with malignant gliomas died; median time from LG diagnosis to death was 20.4 wks (5-91) with 2 pts alive on hospice.
The 2 pts with low grade gliomas died at 11 (oligodendroglioma) and 96 wks (JPA).
All pts with hydrocephalus had VP shunt placed with symptoms improvement.

Conclusion. LG is a rare complication of gliomas readily diagnosable on enhanced MRI.
The main CSF abnormality was increased protein.
The supratentorial compartment was involved in 75%, primarily the temporal lobe (40%).
Response to treatment is poor but VP shunt may help some pts.

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