Search

Background: Cerebrospinal fluid (CSF) shunting refers to the surgical drainage of excess CSF, which arises due to outflow obstruction or a reduction in absorption. Although rare, the dissemination of neoplastic cells along ventriculoperitoneal shunts is well documented, a gap in knowledge exists regarding differences in the direction of neoplastic dissemination along CSF shunts. The aim of this systematic review was to comparatively assess the nature of antegrade and retrograde metastatic spread along CSF shunts. Methodology: A dual systematic review in six major databases was conducted for articles until June 15, 2023, without language restrictions following PRISMA 2020 guidelines and the Cochrane Handbook for Interventional Systematic Reviews. The study focused on the metastasis of both CNS malignancy to extra-neural sites and the retrograde metastasis of extra-neural tumours to the CNS along CSF shunts. Inclusion criteria were case reports with patient characteristics and clinical outcomes. Data were extracted using a standardised table and qualitatively analysed. The JBI case report critical appraisal tool assessed reporting quality. Grey literature was not included. Results: A total of 106 reports of antegrade metastasis were identified representing 121 cases. Patients were most commonly children, with the primary tumour and shunt type being germinomas. Six reports detailing retrograde metastasis met our inclusion criteria with an overall high quality of reporting. All primary tumours were in the abdomen or pelvic cavity with treatment from metastasis depending on patient characteristics. Generally, the prognosis was poor, with one patient succumbing to peritonitis, four cases showing residual disease, and one patient receiving palliative care. Discussion and Conclusion: This updated systematic review noted similar demographic trends regarding the metastasis of CNS malignancy to extra-neural sites through CSF shunts reported by Xu et al. (2018); yet, due to data inaccessibility, updated statistics could not be inferred. Germinomas remained the most common tumour pathology, warranting increased vigilance in patients with germinomas and a CSF shunt. Moreover, this review identified that extra-neural malignancy retrograde CSF shunt metastasis is extremely rare. This study proposes standardised nomenclature for classifying metastasis through CSF shunts for easier clinical identification. [ABSTRACT FROM AUTHOR]