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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Korean+Neurosurg+Soc
2016 ; 59
(6
): 570-576
Nephropedia Template TP
gab.com Text
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English Wikipedia
Retrospective Analysis of Cerebrospinal Fluid Profiles in 228 Patients with
Leptomeningeal Carcinomatosis : Differences According to the Sampling Site,
Symptoms, and Systemic Factors
#MMPMID27847569
Shim Y
; Gwak HS
; Kim S
; Joo J
; Shin SH
; Yoo H
J Korean Neurosurg Soc
2016[Nov]; 59
(6
): 570-576
PMID27847569
show ga
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.