Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery?

Abstract

Our observations with regards to preoperative embolisation of choroid plexus tumours show an acceptable safety profile for the endovascular technique. At the same time, it renders the operative treatment of the tumours safer by reducing perioperative blood loss resulting in a high gross total resection rate. In summary, we suggest that preoperative embolisation is a useful adjunct that should be considered prior to surgical resection in managing these patients.

Superior parietal lobule approach for choroid plexus papillomas without preoperative embolization in very young children

“…Even in recent series, only 54% of unembolized CPPs were completely resected. 11 The superior parietal lobule approach has been reported for CPPs of the atrium, 8,17 and in the current series, it provided excellent exposure and afforded vascular control over all tumors, allowing complete resection with minimal blood loss. There are several rationales for this approach over others.…”

“…6,19,20 It has also been suggested that less intraoperative bleeding due to embolization leads to a higher rate of complete resection and better outcome. 11 However, many series have reported a low rate of successful embolization when attempted due to small tortuous vessels that are difficult or impossible to cannulate, or feeding arteries that are judged to also perfuse deep brain structures. 1,17,20 In addition to these technical difficulties, angiography and embolization are accompanied by small risks of stroke and other complications and should particularly be avoided in the very young because of both deterministic and stochastic long-term radiation effects.…”

“…Intraoperative or postoperative blood transfusion has been mentioned in some small series, 18,20 and in 1 modern series, intraoperative and postoperative transfusion appeared to be routine management. 11 In fact, 2 of the most recent large series have each documented a mean intraoperative blood loss over 100% of each patient's total blood volume, suggesting that most patients at those centers are being transfused routinely. This, taken with the frequent discussion of blood loss and resultant death reported in the literature, suggests that blood transfusion is commonly performed in these patients, though most series do not provide detail on or discussion of the topic.…”

“…1,3,7,10,11,20 One recent series documented a mean intraoperative blood loss of 182% of each patient's blood volume for unembolized CPPs. 11 In published series, the perioperative mortality rate has been reported to range from 0% to 25%, 3,7,[9][10][11][12]16,20,23 and the mortality rate attributed to blood loss has been reported to be as high as 12%. 12 In response to this difficulty, endovascular embolization has been advocated as a means to reduce intraoperative blood loss for these tumors.…”

“…4,11,18,19,22,27 However, each operative approach, as well as any adjunct therapy, has potential complications, so it is essential that methodologies and their outcomes be studied as rigorously as possible despite the rarity of this pathology. It is with this rationale that we sought to examine the outcomes of patients whose tumors are surgically treated with the superior parietal lobule approach without adjunct therapy.…”