Choroid plexus papillomas of the cerebellopontine angle in a child

Cerebello-pontine and Cerebello-medullary Fissure Choroid Plexus Papilloma in a Child - Case Report and Review of Literature

Choroid plexus papillomas (CPP) are commonly seen in the supratentorial compartment in children and only very rarely in the posterior fossa. CPP in the cerebello-pontine angle and cerebello-medullary fissure (CPA) in the pediatric age group are extremely rare with only seven previous cases reported in literature. The authors present the case of a 7-year-old girl who presented with neck tilt, imbalance, and headache. The MRI showed a lesion with a frond-like appearance in the CPA with heterogeneous enhancement. The tumor was excised radically using a cerebello-medullary fissure approach. The authors review and analyze the literature on this rare pediatric tumor, with specific attention to radiology and the surgical aspects.

Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy

Choroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation.

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

Background:

Choroid plexus papillomas (CPPs) comprise around 1% of intracranial neoplasms. The most common location is atrium of the lateral ventricle in children and fourth ventricle in adults. Other rare locations include third ventricle, cerebellopontine (CP) angle and cerebral parenchyma, with only a few cases reported. Authors report three cases of CPP at uncommon locations in pediatric patients. The rarity of these locations, diagnostic dilemma and management aspects are discussed along with an extensive review of the literature.

Methods:

Retrospective institutional data analysis of histopathologically confirmed pediatric CPPs from 2010 to 2014.

Results:

Authors noted three cases of CPP in children in uncommon locations-one each in the posterior third ventricle, fourth ventricle, and CP angle. All were males in the first decade. Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects. Complete excision was achieved in two cases while subtotal removal was performed in one case (fourth ventricular) because of excess blood loss. Mean follow-up duration was 24.6 months (range 20–30 months). One case (of subtotal removal) had fair recovery while other two had excellent outcomes.

Conclusions:

Posterior third ventricle, fourth ventricle, and CP angle are uncommon locations for these tumors in children. Complete surgical removal is the treatment of choice and approach needs to be tailored according to the site and size of the lesion. Blood loss is a major concern in young children as they are highly vascular tumors. Complete removal leads to excellent long-term survival rates. Adjuvant treatment is not required.

Choroid plexus papilloma of the cerebellopontine angle

We report a case of a transdural choroid plexus papilloma of the cerebellopontine angle in a 23-year-old woman. Choroid plexus papillomas are rare intracranial tumors, usually occurring intraventricularly. Those found in the cerebellopontine angle are uncommon and almost always subdural. The investigation, treatment, and follow-up are discussed.

Pleomorphic xanthoastrocytoma of the cerebellopontine angle in a child

CASE REPORT

The case of a 6-year-old girl with a pleomorphic xanthoastrocytoma (PXA) in the left cerebellopontine angle (CPA) is reported. The clinical, radiological, and histopathological findings are presented.

DISCUSSION

To our knowledge, the presence of PXA in the CPA has not previously been reported. The rare infratentorial locations of PXA (frequently seen in association with ganglioglioma) are reviewed, as well as the other infrequent locations of this tumor. This report adds to the list of differential diagnoses of CPA tumors in children.