Embolization of a third ventricular choroid plexus papilloma: illustrative case

Abstract

BACKGROUND Choroid plexus tumors are rare neoplasms that are typically found in the lateral ventricles. They have infrequently been reported in the third ventricle, and treatment strategies have varied. OBSERVATIONS The authors described a 6-month-old patient who presented with irritability and hypotonia. The patient was found to have a large tumor in the third ventricle with obstructive hydrocephalus. Preoperative angiography revealed a feeding artery from the right medial posterior choroidal artery (MPChA). The feeding artery was effectively embolized, and the patient subsequently received open resection of the tumor. Pathology revealed features consistent with atypical choroid plexus papilloma (CPP). LESSONS Choroid plexus tumors are often hypervascular, which can often make gross total resection (GTR) difficult. Preoperative angiography of tumors identifies feeding vessels, and embolization has the potential to decrease perioperative blood loss and allow for a higher GTR rate. Third ventricular CPPs appear to invariably receive vascular supply from the MPChA, arising from the right posterior cerebral artery. Embolization followed by resection of a choroid plexus tumor in the third ventricle is an effective treatment strategy.

Foramen of Monro choroid plexus papilloma: An extremely rare location managed by endoscopic resection

“…Total gross resection persists to be the cornerstone of management in symptomatic patients with a very high success rate and overall prognosis (over 95%) [2 , 9] . However, several other management methods have been studied recently to improve the results and to minimize the complications, such as radiotherapy, adjuvant chemotherapy, and tumor embolization (as CPT are highly vascular tumors with a high risk of bleeding that can be catastrophic, especially in infants and young patients) [2 , 10] . However, there is no consensus on whether to intervene or to follow-up if it is small and asymptomatic due to the very low risk of malignant transformation, although some cases were reported [2 , 7] .…”