Individualised Treatment Approach for Advanced Meningeal Metastases: A Case Study of Ommaya Capsule Implantation

Leptomeningeal metastasis is a rare type of brain metastasis without effective therapeutic guidelines. Herein, we report emergency Ommaya capsule implantation performed for treating meningeal metastases from parathyroid carcinoma in a patient with intracranial hypertension. A 52-year-old woman was admitted to our hospital with recurrent headaches for 2 months and episodic vertigo for 2 days. The patient was hospitalised but did not exhibit abnormal intracranial signals. As her symptoms did not improve following transfer, the patient was diagnosed with a meningeal tumour, with a high suspicion of metastasis from parathyroid cancer. Conservative treatment was ineffective, and her symptoms worsened with severe headaches and shortness of breath. The patient underwent cerebellar hemispherectomy combined with Ommaya capsule implantation in the intensive care unit. Following surgery, she received intrathecal methotrexate injection combined with oral amlotinib. The patient recovered well post-treatment and continued chemotherapy. The patient survived for more than 12 months and ultimately died owing to disease progression. This case demonstrates that simple Ommaya capsule implantation is a safe and effective treatment for patients with advanced leptomeningeal metastasis.This approach is less traumatic and can rapidly control intracranial pressure, create conditions for subsequent treatment, and prolong survival.