Use of tranexamic acid in infants undergoing choroid plexus papilloma surgery: a report of two cases

Abstract

Choroid plexus papilloma (CPP) is a highly vascular tumor of infancy. Reducing blood loss is the key to successful surgical removal of CPPs. Tranexamic acid (TXA) is efficacious in reducing bleeding in craniofacial surgery for infants. This report demonstrates the potential utility of TXA for decreasing blood loss in the removal of vascular tumors in infants. We administered tranexamic acid to two infants with CPP during surgical removal to potentially aid hemostasis and therefore lessen intra-operative bleeding. Gross total surgical resection was accomplished; the patients were hemodynamically stable perioperatively, and the total calculated blood loss was minimal at <20% of the patients' total circulating blood volume. This is the first report of tranexamic acid administration for CPP surgery in children. TXA is an easily administered hemostatic agent and may merit further study as an agent to help reduce intra-operative blood loss in this vulnerable population.

Risk factors for intraoperative allogeneic blood transfusion during craniotomy for brain tumor removal in children

“…Among these strategies, antifibrinolytic agents as tranexamic acid could have interest in reducing the incidence of intraoperative ABT and the amount of blood products transfused. Indeed, the tranexamic acid would be effective in prophylaxis to lower blood loss in children during spine surgery , craniosynostosis , and oncologic neurosurgery , and one case reported its efficacy as rescue during the excision of a brain tumor with massive bleeding in a child . We may also propose the optimization of the hemostasis by intraoperative thromboelastometry that may have an interest to rapidly detect coagulation disturbances not diagnosed using standard coagulation tests .…”

Case series of choroid plexus papilloma in children at uncommon locations and review of the literature

“…[ 6 15 42 ] Recently, intraoperative usage of tranexamic acid has been reported in infants undergoing surgery for these tumors for reducing blood loss. [ 27 ] Management of hydrocephalus is an important aspect due to its ubiquitous accompaniment with these lesions seen in the majority of cases. It remains a topic of controversy, and various options include the placement of an external ventricular drain (EVD) (either preoperatively or during surgery), VP shunt or endoscopic third ventriculostomy (ETV).…”

Update on Applications and Limitations of Perioperative Tranexamic Acid

“…Update on Perioperative Tranexamic Acid in those children with higher risk such as in the trauma setting. 16,[143][144][145] An ongoing prospective trial (ClinicalTrials.gov NCT02840097) is evaluating the benefits and harm of TXA in severely injured children.…”