Abstract
BACKGROUND: Patients with primary or metastatic central nervous system (CNS) tumors may be treated with adjuvant intraventricular chemotherapy or radioimmunotherapy. Effectiveness of the drug may in part depend on adequate drug distribution throughout the thecal space. The incidence of normal, delayed, asymmetric or obstructed cerebrospinal fluid (CSF) flow in the pediatric population with CNS tumors prior to intraventricular therapy has not been described. METHODS: We performed a retrospective review of patients with primary or metastatic CNS tumors treated at MSK over a 15-year period (2003–2018). Patients underwent 111-indium diethylene triamine pentaacetic acid (DTPA) injection into the CSF with nuclear medicine imaging at 90 min-4 hours, 24 hours and 48 hours (if required). CSF flow studies were classified as normal, delayed, asymmetric or obstructed. RESULTS: 278 CSF flow studies were performed in 224 patients, 202 (90%) < 18 years of age. 116 (52%) of patients had metastatic CNS neuroblastoma, 57 (25%) had medulloblastoma and 51 (23%) had other CNS histologies. Of the 278 flow studies, 237 (85%) were normal, 9 (3%) were obstructed requiring neurosurgical intervention, 25 (9%) were delayed and 7(3%) were asymmetric. CONCLUSIONS: Abnormal CSF flow studies are noted in 15% of pediatric patients with CNS tumors; 3% of patients will require a procedure to improve adequate flow prior to receiving intraventricular therapy. These results have implications for successful delivery of intraventricular therapies.