Glial Tumor Metastases Through a Ventriculo-Pleural Shunt

EXTRACRANIAL metastases from central nervous system (CNS) neoplasms are unusual and in the great majority of instances follow surgery at the primary site.¹Zimmerman²has shown experimentally in mice that if glial tumor cells are given access to the systemic circulation, they implant and grow in lung, liver, and other organs. It has therefore been suggested that surgery facilitates metastasis by opening paths of exit from the CNS not usually available because of the blood-brain barrier, absence of lymphatic drainage, and perhaps raised intracranial pressure.³,⁴ The present report describes spread of an atypical cerebellar astrocytoma to pleura through a ventriculo-pleural shunt. It is the fifth recorded example of spread through a shunt,⁴⁻⁶and as a result of the massive effusion which occurred, the first in which the diagnosis was made before death. Report of a Case A 19-year-old man was admitted on Sept