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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Choroid plexus papillomas (CPPs) are rare neoplasms, often found in the atrium of the lateral ventricle of infants, and cause overproduction hydrocephalus. The extensive vascularity and medially located blood supply of these tumors, coupled with the young age of the patients, can make prevention of blood loss challenging. Preoperative embolization has been advocated to reduce blood loss and prevent the need for transfusion, but this mandates radiation exposure and the additional risks of vessel injury and stroke. For these reasons, the authors present their experience using the superior parietal lobule approach to CPPs of the atrium without adjunct therapy.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective review was conducted of all children who presented to Columbia University/Morgan Stanley Children's Hospital of New York with a CPP in the atrium of the lateral ventricle and who underwent surgery using a superior parietal lobule approach without preoperative embolization.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Nine children were included, with a median age of 7 months. There were no perioperative complications or new neurological deficits. All patients had intraoperative blood loss of less than 100 ml, with a mean minimum hematocrit of 26.9% (range 19.6%–36.2%). No patients required a blood transfusion. The median follow-up was 39 months, during which time no patient demonstrated residual or recurrent tumor on MRI, nor did any have an increase in ventricular size or require CSF diversion.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The superior parietal lobule approach is safe and effective for very young children with CPPs in the atrium of the lateral ventricle. The results suggest that preoperative embolization is not essential to avoid transfusion or achieve overall good outcomes in these patients. This management strategy avoids radiation exposure and the additional risks associated with embolization.</jats:p></jats:sec>

Infantile epileptic spasms syndrome as an initial presentation in infantile choroid plexus papilloma: A case report

“…CPP is a rare intracranial tumor and is classified as grade I by the World Health Organization classification of tumors. In the pediatric age group, half occur in the first year of life ( 4 ). At any time of diagnosis, hydrocephalus is noted in almost all cases due to much cerebrospinal fluid (CSF) produced by the tumor and the blocked CSF circulation pathway ( 5 ).…”

“…Choroid plexus papilloma (CPP) develops as an intraventricular neoplasm arising from the epithelium of the choroid plexus and affects children and infants disproportionately with an incidence of 4% in all pediatric brain tumors ( 1 , 2 ). CPP is commonly found in the lateral ventricles with a rate of 43%–65%, followed by the fourth and the third ventricle, and less in other regions ( 3 , 4 ). Hydrocephalus, macrocephaly, enlarged fontanelles, and symptoms of intracranial hypertension are noted in nearly all clinical cases with CPP ( 5 , 6 ).…”

Third ventricular choroid plexus papilloma: a pure neuroendoscopic approach

“…The first stage of resection involved a left temporoparietal craniotomy to remove the left atrial component. 1 An open approach was utilized due to the unknown vascularity of the tumor. A postoperative external ventricular drain was placed, and pathology was consistent with an atypical choroid plexus papilloma.…”

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

“…1a). In the pediatric age group, half occur in the first year of life [4,12,30,41,66,[76][77][78]. Hydrocephalus, macrocephaly, and a mass on imaging are the major presenting findings.…”

“…Cysts develop within the tumor or adjacent cortex in 7.5% of patients with CPPs. They are found on imaging either before birth, after birth, or following surgical resection [2,19,31,41,52,76]. Cysts range in size and occur on or directly beneath the ependymal lining.…”