Treatment Modalities for Leptomeningeal Metastases

The effect of intrathecal chemotherapy on the survival of patients with leptomeningeal metastasis from breast cancer. Survival curves are given for the intraventricular treatment (IT) group versus the no-IT group. At 1 year, estimated survival was 18% (±9% [SE]) for the IT arm and 32% (±12%) for the no-IT arm (P = .32, log-rank test). Median survival was 18.3 weeks (±6.7) in the IT arm and 30.3 weeks (±10.9) weeks in the no-IT arm (P = NS). Reprinted with permission.⁵⁸ Copyright © 2004 Elsevier Ltd.

Cerebrospinal fluid (CSF) production and circulation depicted on a coronal brain section of the posterior central nervous system (CNS). CSF originates from the choroid plexi of the lateral and third ventricles and flows downward through the narrow cerebral aqueduct (arrows). It then empties into the fourth ventricle and is driven downward around the spinal cord (subarachnoid space) and upward over the convexities of the cerebral hemispheres. CSF flows outward into the venous blood of the superior sagittal sinus and also into the lymphatic system of the eye and nose.