蛛网膜下腔转移瘤（LM）与50%-70%的患者出现脑脊液流动动力学改变相关。约1%-5%的患者发展出症状性LM相关性脑积水（LM-H），对生活质量（QOL）、功能状态和总体生存期（OS）产生不利影响。关于LM-H的脑脊液引流程序存在平衡状态。本系统回顾和荟萃分析旨在评估在此背景下脑脊液引流对OS和QOL的影响。本系统回顾根据PRISMA指南进行。通过搜索PubMed/Medline、Embase、Web of Science和Scopus等数据库，筛选出评估针对成年患者体内恶性肿瘤相关LM-H的脑脊液引流角色的文章。采用随机效应模型进行荟萃分析，并报告平均差异和95%的置信区间。使用Risk of Bias in Nonrandomized Studies of Interventions（ROBINS-I）工具评估偏倚。共纳入10项符合条件的研究，共494名患者。两项研究报道了中位数OS的多因素HR，提示脑室分流对OS无明显影响（汇总HR为0.42，95% CI 0.09-1.94，p = 0.27）。通过4项研究计算得到术前和术后Karnofsky绩效状态的平均值差异为17.6分（95% CI 10.44-24.68，p < 0.0001）。在所有研究中观察到症状改善率为67%-100%，头痛和恶心症状的改善率较高，而颅神经麻痹的改善率较低。9项研究中的并发症发生率范围为0%至21.1%。根据目前的研究结果，分流治疗对OS没有改善作用，但可以缓解症状，因此建议考虑出现特定症状的个体进行脑脊液引流。当前结果提示制定标准化决策工具，并对个体患者的风险-效益比进行批判性分析。实施这些举措将优化LM-H患者的外科管理。

Leptomeningeal metastasis (LM) is associated with altered CSF flow dynamics in 50%-70% of patients. Approximately 1%-5% of patients develop symptomatic LM-associated hydrocephalus (LM-H), which adversely impacts quality of life (QOL), functional status, and overall survival (OS). There is equipoise for CSF diversion procedures in LM-H. This systematic review and meta-analysis aimed to assess the effect of CSF diversion on OS and QOL in this context.This systematic review was conducted according to the PRISMA guidelines. PubMed/Medline, Embase, Web of Science, and Scopus were searched for articles that evaluated the role of CSF diversion for LM-H due to systemic cancer in adult patients. A meta-analysis was conducted using random effects models, with mean differences and 95% CIs reported. Bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool.Ten eligible studies with a total of 494 patients were included. Two studies reported multivariate HRs for median OS, suggesting no significant effect of shunting on OS (pooled HR 0.42, 95% CI 0.09-1.94, p = 0.27). A difference between preoperative and postoperative Karnofsky Performance Status of mean 17.6 points (95% CI 10.44-24.68, p < 0.0001) was calculated from 4 studies. Across all studies, a symptomatic improvement rate of 67%-100% was observed, with high rates of improvement for headaches and nausea and lower rates for cranial nerve palsies. Complication rates across 9 studies ranged from 0% to 21.1%.Based on the present findings, shunting does not improve OS but does relieve symptoms, suggesting that individuals who exhibit certain symptoms should be considered for CSF diversion. The present findings prompt the generation of a standardized decision-making tool and a critical analysis of the individual patient risk-benefit ratio. Implementation of these will optimize surgical management of LM-H patients.