Treatment of third ventricular choroid plexus papilloma in an infant with embolization alone

Case report

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The authors present the case of a 3-month-old boy with a third ventricular tumor consistent with a choroid plexus papilloma. This child presented with macrocephaly, irritability, inability to roll over, and vomiting. He was found to have an enlarged head circumference, a full and tense fontanel, splayed sutures, and forced downward gaze. Imaging revealed severe ventriculomegaly and a brightly enhancing third ventricular lesion consistent with papilloma. Treatment planning included placement of a ventriculoperitoneal shunt to treat hydrocephalus and to allow the child to grow prior to resection. Due to the vascular nature of these tumors and the age of this child, the tumor was embolized with a plan for eventual resection; however, embolization resulted in involution and total regression of the tumor. There is no residual disease at last follow-up of 16 months. In this specific scenario of a choroid plexus papilloma in an infant, when operative intervention may be technically difficult and associated with significant morbidity, embolization with close observation may be a valid treatment option. If used, the patient would need to be closely followed for evidence of residual or recurrent disease, which would require operative intervention.

Abbreviations used in this paper: CPP = choroid plexus papilloma; EVD = external ventricular drain.

Article Information

Address correspondence to: John S. Myseros, M.D., Division of Neurological Surgery, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC. email: jmyseros@cnmc.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Postcontrast axial (left) and coronal (right) T1-weighted MR images demonstrating characteristic findings of CPP within the third ventricle, which was associated with massive hydrocephalus.

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    Anteroposterior arteriogram of superselective catheterization of the right medial posterior choroidal artery prior to Onyx injection.

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    Anteroposterior arteriogram of left vertebral artery following Onyx embolization of the right medial posterior choroidal artery.

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    Postcontrast axial (left) and coronal (right) T1-weighted MR imaging sequences demonstrating no residual tumor at the 16-month follow-up and decreased ventricular size.

References

  • 1

    Buxton NPunt J: Choroid plexus papilloma producing symptoms by secretion of cerebrospinal fluid. Pediatr Neurosurg 27:1081111997

  • 2

    Due-Tønnessen BHelseth ESkullerud KLundar T: Choroid plexus tumors in children and young adults: report of 16 consecutive cases. Childs Nerv Syst 17:2522562001

    • Search Google Scholar
    • Export Citation
  • 3

    Fujimura MOnuma TKameyama MMotohashi OKon HYamamoto K: Hydrocephalus due to cerebrospinal fluid overproduction by bilateral choroid plexus papillomas. Childs Nerv Syst 20:4854882004

    • Search Google Scholar
    • Export Citation
  • 4

    Ghatak NRMcWhorter JM: Ultrastructural evidence for CSF production by a choroid plexus papilloma. J Neurosurg 45:4094151976

  • 5

    Jeibmann AWrede BPeters OWolff JEPaulus WHasselblatt M: Malignant progression in choroid plexus papillomas. J Neurosurg 107:3 Suppl1992022007

    • Search Google Scholar
    • Export Citation
  • 6

    Kumar RSingh S: Childhood choroid plexus papillomas: operative complications. Childs Nerv Syst 21:1381432005

  • 7

    Lena GGenitori LMolina JLegatte JRChoux M: Choroid plexus tumours in children. Review of 24 cases. Acta Neurochir (Wien) 106:68721990

    • Search Google Scholar
    • Export Citation
  • 8

    Longatti PBasaldella LOrvieto EDei Tos AMartinuzzi A: Aquaporin(s) expression in choroid plexus tumours. Pediatr Neurosurg 42:2282332006

    • Search Google Scholar
    • Export Citation
  • 9

    Nagib MGO'Fallon MT: Lateral ventricle choroid plexus papilloma in childhood: management and complications. Surg Neurol 54:3663722000

    • Search Google Scholar
    • Export Citation
  • 10

    Otten MLRiina HAGobin YPSouweidane MM: Preoperative embolization in the treatment of choroid plexus papilloma in an infant. Case report. J Neurosurg 104:6 Suppl4194212006

    • Search Google Scholar
    • Export Citation
  • 11

    Pawar SJSharma RRMahapatra AKLad SDMusa MM: Choroid plexus papilloma of the posterior third ventricle during infancy & childhood: report of two cases with management morbidities. Neurol India 51:3793822003

    • Search Google Scholar
    • Export Citation
  • 12

    Pencalet PSainte-Rose CLellouch-Tubiana AKalifa CBrunelle FSgouros S: Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 88:5215281998

    • Search Google Scholar
    • Export Citation
  • 13

    Pietrini DCiano FForte EPusateri AValenti MZanghi F: Massive blood loss during removal of congenital choroid plexus tumors. J Neurosurg Anesthesiol 16:2602632004

    • Search Google Scholar
    • Export Citation
  • 14

    Rickert CHPaulus W: Tumors of the choroid plexus. Microsc Res Tech 52:1041112001

  • 15

    Schijman EMonges JRaimondi AJTomita T: Choroid plexus papillomas of the III ventricle in childhood. Their diagnosis and surgical management. Childs Nerv Syst 6:3313341990

    • Search Google Scholar
    • Export Citation
  • 16

    Tacconi LDelfini RCantore G: Choroid plexus papillomas: consideration of a surgical series of 33 cases. Acta Neurochir (Wien) 138:8028101996

    • Search Google Scholar
    • Export Citation

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