Leptomeningeal dissemination of malignant gliomas. Incidence, diagnosis and outcome

To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem....

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Bibliographic Details
Published in:Acta neurochirurgica 1994-06, Vol.126 (2-4), p.84-92
Main Authors: ARITA, N, TANEDA, M, HAYAKAWA, T
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Astrocytoma - diagnosis
Astrocytoma - pathology
Astrocytoma - secondary
Astrocytoma - surgery
Biological and medical sciences
Brain Neoplasms - diagnosis
Brain Neoplasms - pathology
Brain Neoplasms - surgery
Child
Child, Preschool
Female
Follow-Up Studies
Glioblastoma - diagnosis
Glioblastoma - pathology
Glioblastoma - secondary
Glioblastoma - surgery
Glioma - diagnosis
Glioma - pathology
Glioma - secondary
Glioma - surgery
Humans
Infant
Magnetic Resonance Imaging
Male
Medical sciences
Meningeal Neoplasms - diagnosis
Meningeal Neoplasms - pathology
Meningeal Neoplasms - secondary
Meningeal Neoplasms - surgery
Meninges - pathology
Meninges - surgery
Middle Aged
Neurology
Postoperative Complications - mortality
Retrospective Studies
Survival Rate
Tomography, X-Ray Computed
Tumors of the nervous system. Phacomatoses
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Summary:To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem. Eleven patients had neurological deficits due to dissemination, whereas the other 9 without these had CT or myelographic evidence of dissemination. The peak incidence of dissemination was seen in the first and second decades of life. The mean age of 22 patients with dissemination was 31 years, significantly lower than that (44.5 years) of patients without dissemination. Fifteen patients developed dissemination within one year after diagnosis (early dissemination), 60% of them were less than 30 years of age. All patients with late dissemination (more than one year after diagnosis) underwent a second craniotomy for tumour removal before dissemination, while none of the 15 patients with early dissemination did. Survival after diagnosis in patients with dissemination was shorter, although statistically not significant, than that of patients without dissemination. Survival after dissemination was limited in all patients (mean 19 weeks, range 2-39 weeks). Immunohistochemical study revealed that the disseminated tumour expressed less glial fibrillary acidic protein than the primary tumour. Our results suggest that dissemination does not seem to result from extended survival of the patients, but may occur at any time in malignant gliomas. Some malignant gliomas, especially in younger patients, have a capability to acquire biological characteristics suitable for dissemination in the earlier stage of the disease.
ISSN:0001-6268
0942-0940
DOI:10.1007/bf01476415