A case of carcinomatous meningitis: therapy and symptom management using an intrathecal catheter with subcutaneous port

Abstract

In general, intrathecal opioid administration is considered for intractable cancer pain management. We would like to report a case of carcinomatous meningitis that was successfully treated by using an intrathecal catheter with subcutaneous port. A female in her fifties with carcinomatous meningitis secondary to invasive ductal breast cancer was suffering multiple neurological symptoms including headache. Intrathecal catheterization with subcutaneous port was considered as an alternative to Ommaya reservoir placement to continue intrathecal antineoplastic treatment. The port was used for collection of CSF, antineoplastic drug administration and opioid delivery. Neoplastic cells in the CSF disappeared within one month and the headache and other neurological symptoms improved. The patient died five months post diagnosis (four months after initiation treatment via intrathecal catheter) without recurrence of significant headache, before developing coma seven days prior to death. This case suggests an intrathecal catheter with subcutaneous port may be used effectively for both symptom management and the administration of antineoplastic drugs. However, further study is necessary.