P17.06.B CSF DRAINAGE IN LEPTOMENINGEAL DISEASE: SURGICAL AND SURVIVAL OUTCOMES IN VENTRICULO-PERITONEAL SHUNT VS. RICKHAM RESERVOIR PATIENTS

Abstract BACKGROUND Leptomeningeal disease (LMD) usually represents a terminal condition that can cause symptomatic hydrocephalus. With improved survival rates under systemic therapy, the role of cerebrospinal fluid (CSF) drainage via ventriculo-peritoneal shunt (VPS) or Rickham reservoir placement for symptom control is gaining more relevance. This study aimed to describe surgical and survival outcomes of hydrocephalic LMD patients after surgical drainage in a contemporary cohort. MATERIAL AND METHODS A multi-center retrospective analysis of adult patients with VPS or Rickham reservoir placement for CSF drainage in the presence of LMD with malresorptive hydrocephalus between 2017 and 2022 was performed. Patients with occlusive hydrocephalus were excluded. Clinical, surgical and survival data were collected and compared. RESULTS A total of 119 patients with a median age of 53 (42-77) years (40 males, 79 females) were included. Of those, 64 underwent VPS (54%) and 55 (46%) Rickham reservoir placement. The most common underlying oncological conditions were breast cancer (n=67, 56%) and non-small cell lung cancer (n=25, 21%). The median time between primary tumor and LM diagnosis was 23 months (0 to 180 months) and 44 patients (37%) had end-stage disease at primary tumor diagnosis. Moreover, 79 (66%) patients showed solid intraparenchymal cranial metastases, for which only 20 patients (17%) had received surgical resection. Most patients (n=95, 80%) presented with symptoms of intracranial hypertension, which were relieved in 79% (n=51/64) after surgery. Compared to VPS placement, Rickham reservoirs were associated with lower complication (11% vs. 30%, p=0.01) and revision (9% vs. 23%, p=0.049) rates. Median overall survival from surgery was 90 (23 -148) days, and longer in VPS patients (107 days) compared to Rickham patients (83 days). However, this difference did not reach statistical significance (p=0.512). CONCLUSION While surgical CSF drainage in patients with LM disease relieves symptoms of intracranial hypertension in many cases, median survival remains expectedly low. Compared to Rickham reservoir placement, VPS bears higher rates of complications and revisions without a clear survival benefit. Nevertheless, decision-making regarding surgical CSF drainage and more importantly VPS or Rickham reservoir placement in LMD patients retains an individual and palliative nature.