Feasibility and value of preoperative embolization of a congenital choroid plexus tumour in the premature infant: An illustrative case report with technical details

Abstract

<jats:p> We present a case of a preterm boy (born at 35 weeks of pregnancy) who was delivered urgently by a caesarean section due to placental abruption. The baby was found to have a tense fontanelle leading to imaging that showed a 5.5 cm right intraventricular mass centred in the atrium, hydrocephalus and extensive surrounding vasogenic oedema. The mass was avidly enhancing with a few large associated vessels suggesting high vascularity. The condition of the baby was acutely deteriorating. He had multiple seizures followed by persistent low level of consciousness in the third day of life. His clinical decline prompted decision to proceed with surgical resection and preoperative embolization. A large single feeder (the right posterolateral choroidal artery) was embolized leading to near complete obliteration of the tumour blush. Embolization likely facilitated subsequent surgery the next day. This is based on an estimated blood loss of 250 ml in this 3 kg baby without haemodynamic instability. Gross total resection was achieved with a single surgery and the diagnosis was choroid plexus papilloma. Utilization of this combined approach in this preterm baby had led to survival in this potentially curable disease. </jats:p>

Microscopic and endoscopic “chopstick” technique removal of choroid plexus papilloma in the third ventricle of an infant: a case report with systematic review of literature

“…Forty full-text articles were evaluated. Eighteen articles were finally included for analysis (Table 1; Figure 4) (1,3,4,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The majority of the articles were case reports, and included a total of 30 cases with a pathological diagnosis of CPP.…”

“…MRI shows equal or low T1 signal and high T2 signal ( 2 ). In addition to surgical removal of the tumor, cerebrospinal fluid shunts or interventional embolization can be performed preoperatively ( 10 ). The most common surgical treatment for CPP is transcortical approach by a microscope ( 22 ).…”

“…The survival rate after surgical resection of CPP is high, and it has been reported that the long-term survival rate ranges from 90% to 100% with gross total resection ( 11 ). For infant patients with a high surgical risk, preoperative tumor interventional embolization has been proposed ( 4 , 10 ). Preparation of cerebrospinal fluid shunt alone may also complement CPP treatment ( 19 ).…”

Perinatal (fetal and neonatal) choroid plexus tumors: a review

“…Survival with surgical resection alone approximates 95% in this age group (Table 1). When the tumor embolization regimen was added to two CPP cases prior to surgery, both infants survived [3]. Siegfried et al reported similar survivals (100%) in 54 CPPs under the age of 18 [67].…”