A 54-year-old woman with metastatic breast cancer presents with progressive headache, diplopia (CN VI palsy), facial weakness (CN VII palsy), and lower limb radiculopathy. Gadolinium-enhanced MRI brain and spine shows linear enhancement outlining the cortical sulci and basal cisterns, with communicating hydrocephalus. The radiologic finding marked **A** in the diagram is leptomeningeal carcinomatosis. Before initiating intrathecal chemotherapy, which of the following investigations is MANDATORY to prevent drug pooling and neurotoxicity?
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