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Pongeluppi RI, Ballestero MFM, Santos MV, Oliveira RSD. Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:825-834. [PMID: 37604205 PMCID: PMC10550351 DOI: 10.1055/s-0043-1770351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/09/2023] [Indexed: 08/23/2023]
Abstract
Choroid plexus papillomas (CPPs) are rare benign neoplasms which are particularly uncommon in the posterior fossa in children. We herein present a case series of five patients treated at a tertiary care hospital. A comprehensive literature review was also carried out. The patients treated at the tertiary care hospital were aged between 4 and 16 years. Gross total resection (GTR) was initially achieved in two patients. All patients showed clinical improvement. Moreover, 27 articles published between 1975 and 2021 were selected for the literature review, totaling 46 patients; with the 5 patients previously described, the total sample was composed of 51 cases, With a mean age was 8.2 years. The lesions were located either in the fourth ventricle (65.3%) or the cerebellopontine angle (34.7%). Hydrocephalus was present preoperatively in 66.7% of the patients, and a permanent shunt was required in 31.6% of the cases. The GTR procedure was feasible in 64.5%, and 93.8% showed clinical improvement. For CPPs, GTR is the gold standard treatment and should be attempted whenever feasible, especially because the role of the adjuvant treatment remains controversial. Neuromonitoring is a valuable tool to achieve maximal safe resection. Hydrocephalus is common and must be recognized and promptly treated. Most patients will need a permanent shunt. Though there is still controversy on its efficacy, endoscopic third ventriculostomy is a safe procedure, and was the authors' first choice to treat hydrocephalus.
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Affiliation(s)
- Rodrigo Inácio Pongeluppi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Matheus Fernando Manzolli Ballestero
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
- Universidade Federal de São Carlos, Departamento de Medicina, São Carlos SP, Brazil.
| | - Marcelo Volpon Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Ricardo Santos de Oliveira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
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Sridhar K, Subramaniam S. Cerebello-pontine and Cerebello-medullary Fissure Choroid Plexus Papilloma in a Child - Case Report and Review of Literature. Neurol India 2021; 69:729-732. [PMID: 34169877 DOI: 10.4103/0028-3886.319229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- K Sridhar
- Department of Neurosurgery, Institute of Neurosciences and Spine, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Sushanth Subramaniam
- Department of Neurosurgery, Institute of Neurosciences and Spine, MGM Healthcare, Chennai, Tamil Nadu, India
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Anderson M, Babington P, Taheri R, Diolombi M, Sherman JH. Unique presentation of cerebellopontine angle choroid plexus papillomas: case report and review of the literature. J Neurol Surg Rep 2013; 75:e27-32. [PMID: 25083384 PMCID: PMC4110152 DOI: 10.1055/s-0033-1358378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 09/01/2013] [Indexed: 11/27/2022] Open
Abstract
Objectives We present the case of a choroid plexus papilloma (CPP) in the cerebellopontine angle (CPA), describe the different appearances of CPPs with a variety of imaging techniques, and discuss the differential diagnosis of CPA tumors. Participant and Design We report the case of a 52-year-old woman with headache, tinnitus, and unilateral hearing impairment whose preoperative magnetic resonance imaging revealed a heterogeneously enhancing CPA mass that extended into the internal auditory canal. Main Outcome Measures, Results, and Conclusion The preoperative imaging appearance of the lesion was most consistent with that of a schwannoma. Postoperative histopathologic examination found the tumor to be a CPP with cuboidal epithelial cells overlying fibrovascular stroma. CPPs are rare benign central nervous system neoplasms arising from choroid plexus epithelium. The most common site of presentation is in the fourth ventricle in adults and the lateral ventricles in children. CPPs rarely occur in the CPA, and when they do, clinical-radiologic diagnosis is difficult due to both the rarity of this presentation and to nonspecific radiological features.
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Affiliation(s)
- Mark Anderson
- School of Medicine, The George Washington University School of Medicine, Washington, District of Columbia, United States
| | - Parker Babington
- Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States
| | - Reza Taheri
- Department of Radiology, The George Washington University, Washington, Washington, District of Columbia, United States
| | - Mairo Diolombi
- Department of Pathology, The George Washington University, Washington, District of Columbia, United States
| | - Jonathan H Sherman
- Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States
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Maimone G, Ganau M, Nicassio N, Paterniti S. Paratrigonal choroid plexus papilloma presenting with satellite multiple supra- and infratentorial hemorrhages. Neuroanatomical basis and pathological hypothesis. Int J Surg Case Rep 2013; 4:239-42. [PMID: 23333804 DOI: 10.1016/j.ijscr.2012.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/19/2012] [Accepted: 11/25/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Choroid plexus papillomas (CPP) are rare tumors arising from the neuroepithelium of the choroid plexus. PRESENTATION OF CASE We report a case of a patient operated for a paratrigonal hemorrhagic WHO class I CPP presenting with multiple satellite supra- and infratentorial hemorrhages. Clinical presentation was characterized by sudden hemiparesis, speech impairment and consciousness deterioration; neuroradiological imaging showed a huge contrast-enhanced solid hemorrhagic left paratrigonal lesion along with others multifocal right occipital and vermian hemorrhages. The patient underwent urgent intervention for excision of the paratrigonal lesion, whose histological analysis led to the diagnosis of CPP. A few days later due to failure of conservative treatment of the satellite hemorrhages the patient underwent a second-time surgery for their evacuation; interestingly histological examination of the tissue probe did not reveal any neoplastic features confirming their sole hemorrhagic nature. Patient's conditions slowly improved despite severe neurological deficits, without any further tumor recurrence. DISCUSSION A thorough revision of the literature is provided including previous reported cases of spontaneous bleeding CPPs and other underlying causes that could lead to multifocal hemorrhages. CONCLUSION Due to the rarity of these events, this case remains still open to speculative hypotheses drawn to explain the neuroanatomical and pathogenetic basis behind this case report.
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Affiliation(s)
- G Maimone
- Department of Neurosurgery, Policlinic University of Messina, 98126 Messina, Italy.
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Panizza BJ, Jackson A, Ramsden RT, Lye RH. Choroid plexus papilloma of the cerebellopontine angle. Skull Base Surg 2011; 2:155-60. [PMID: 17170859 PMCID: PMC1656364 DOI: 10.1055/s-2008-1057127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Jinhu Y, Jianping D, Jun M, Hui S, Yepeng F. Metastasis of a histologically benign choroid plexus papilloma: case report and review of the literature. J Neurooncol 2007; 83:47-52. [PMID: 17387433 DOI: 10.1007/s11060-006-9300-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
Cerebrospinal metastases of benign choroid plexus papillomas (CPPs) are extremely rare. We report a case of 32-year-old woman who presented with a 6-month history of vertigo and intermittent headache. Plain CT scan of the cranium revealed a partly calcified tumor filling the fourth ventricle and its right recess. Cranial MRI showed an inhomogeneously contrast-enhancing tumor and leptomeningeal enhancement encasing the brain stem. Complete resection of the tumor was carried out, and seedings to the floor of the fourth ventricle and cervico-medullary junction were found during the operation. While intraoperative frozen section suggested pathology of papillary ependymoma or CPP, to our surprise, final histological examination revealed a benign choroid plexus papilloma. One month after the first operation, a metastatic nodule was found in the spinal subarachnoidal space at the level of T8-9. Two months after the first operation, on follow-up MRI of the cranium, the leptomeningeal enhancement encasing the brain stem had resolved spontaneously. This special case helps increase our understanding of benign CPPs and expands our differential diagnostic consideration of lesions with similar manifestations.
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Affiliation(s)
- Ye Jinhu
- Department of Neuroradiology, Beijing Tiantan Hospital, Tiantan xili street 10, Beijing 100050, China.
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McIver JI, Link MJ, Giannini C, Cohen-Gadol AA, Driscoll C. Choroid plexus papilloma and meningioma: coincidental posterior fossa tumors: case report and review of the literature. ACTA ACUST UNITED AC 2003; 60:360-5. [PMID: 14505866 DOI: 10.1016/s0090-3019(03)00157-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We report an unusual case of an extraventricular choroid plexus papilloma (CPP) occupying the right ventral foramen magnum and lower right cerebellopontine angle (CPA), occurring together with a petro-tentorial meningioma. The clinical presentation, preoperative imaging, differential diagnosis, surgical treatment and histologic features of the two tumors are discussed. CASE DESCRIPTION The patient presented with a 2-month history of headache, altered facial sensation, dysphagia, and gait unsteadiness. Neurologic examination confirmed a wide-based, unsteady gait, hoarse voice, anisocoria, and partial right vocal cord paralysis. Diagnostic imaging demonstrated right petro-tentorial and right ventral foramen magnum lesions, both hyperintense on contrasted images and suggestive of meningiomas. A right suboccipital craniotomy and far lateral approach was used to resect both tumors. The petro-tentorial tumor was a histologically confirmed meningioma, but the ventral foramen magnum tumor was an extraventricular CPP. CONCLUSIONS This is a rare occurrence of concomitant meningioma and CPP. There is no known link between these two tumors. An exophytic 4th ventricular CPP must be considered in the differential diagnosis of a CPA or foramen magnum tumor.
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Affiliation(s)
- Jon I McIver
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Shin JH, Lee HK, Jeong AK, Park SH, Choi CG, Suh DC. Choroid plexus papilloma in the posterior cranial fossa: MR, CT, and angiographic findings. Clin Imaging 2001; 25:154-62. [PMID: 11679220 DOI: 10.1016/s0899-7071(01)00284-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study, we reviewed the magnetic resonance (MR, n=5), computed tomography (CT, n=3), and angiography (n=3) of six patients with pathologically confirmed choroid plexus papilloma (CPP) in the posterior cranial fossa. CPPs in the posterior cranial fossa have several features, including a propensity to arise at the foramen of Luschka with extraventricular extension, occasional peritumoral signal voids/cysts or calcification, weaker enhancement on MR or CT, and less strong tumor staining by the anterior or posterior inferior cerebellar artery or angiography.
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Affiliation(s)
- J H Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-ku, Seoul 138-736, South Korea
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Talacchi A, De Micheli E, Lombardo C, Turazzi S, Bricolo A. Choroid plexus papilloma of the cerebellopontine angle: a twelve patient series. SURGICAL NEUROLOGY 1999; 51:621-9. [PMID: 10369230 DOI: 10.1016/s0090-3019(99)00024-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Choroid plexus papillomas (CPPs), of the cerebellopontine angle (CPA), are a rare entity and no surgical series have been reported so far. We reviewed all the pertinent literature of 12 patients operated on in the last 20 years at our institution. METHODS All the patients were adults, ranging from 19 to 61 years. The group included 6 males and 6 females. Preoperatively, on computerized tomography (CT) (n = 10) or magnetic resonance imaging (MRI) (n = 4), differential diagnosis was difficult to achieve, especially with meningiomas. Hydrocephalus was disclosed in 8 cases. Angiography (n = 11) showed tumor blush with typical vascular supply in almost half the cases. RESULTS In 6 patients a midline approach via the cerebellomedullary fissure was used; in the remaining 6 patients the retromastoid route was adopted. We found 2 "unconnected" tumors; no hilum was identified at surgery. Total tumor removal was achieved in 6 patients, predominantly in the last cases. Two patients died in the postoperative period, 3 patients had mild additional deficits, whereas 7 patients were stable or improved. All the patients were followed up for a mean period of 8.2 years. Conventional radiotherapy was carried out in 5 patients; 1 of them after tumor recurrence. Stereotactic radiotherapy was performed in 3 patients; 2 of them after recurrences. Two patients showed tumor progression and died during the follow-up. One of them presented a suprasellar metastasis and died much earlier (2 versus 7 years). CONCLUSION Careful assessment and surgical planning is accomplished with the combined information from CT, MRI, and angiography. Typical characteristics are the following: vascular supply from the choroidal arteries, ventral extension, adhesion to the brainstem, and lower cranial nerves. Nowadays, total removal of CPPs of the CPA can be achieved with acceptable morbidity and mortality. In our experience, conventional radiotherapy did not prove effective.
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Affiliation(s)
- A Talacchi
- Department of Neurological Sciences and Vision, University and Hospital, Verona, Italy
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Tasdemiroglu E, Awh MH, Walsh JW. MRI of cerebellopontine angle choroid plexus papilloma. Neuroradiology 1996; 38:38-40. [PMID: 8773273 DOI: 10.1007/bf00593214] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a cerebellopontine angle choroid plexus papilloma that originated from the tuft of choroid plexus of the fourth ventricle protruding from the foramen of Luschka. MRI and CT did not establish the diagnosis, but the tumor was shown histopathologically to be a choroid plexus papilloma. Distinct features of the tumor on MRI are described and the differential diagnosis of other cerebellopontine angle tumors is discussed.
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Affiliation(s)
- E Tasdemiroglu
- Veterans Affairs Medical Center, Neurosurgery Service, Lexington, KY 40511, USA
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Furuya K, Sasaki T, Saito N, Atsuchi M, Kirino T. Primary large choroid plexus papillomas in the cerebellopontine angle: radiological manifestations and surgical management. Acta Neurochir (Wien) 1995; 135:144-9. [PMID: 8748805 DOI: 10.1007/bf02187759] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two cases of primary choroid plexus papilloma originating in the cerebellopontine angle (CPA) are reported. Both papillomas were encapsulated and strongly adhering to a choroid plexus tuft protruding from the foramen of Luschka. Successful removal of the tumour was achieved in each case. Surgical strategy, neuroradiological manifestations, and the differential diagnosis are discussed.
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Affiliation(s)
- K Furuya
- Department of Neurosurgery, University of Tokyo Hospital, Japan
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Enomoto H, Mizuno M, Katsumata T, Doi T. Intracranial metastasis of a choroid plexus papilloma originating in the cerebellopontine angle region: a case report. SURGICAL NEUROLOGY 1991; 36:54-8. [PMID: 2053075 DOI: 10.1016/0090-3019(91)90134-u] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors present a rare case in which a choroid plexus papilloma originating in the left cerebellopontine angle region metastasized and formed a space-occupying lesion in the right temporal region. A 46-year-old woman with choked disks presented with two separate mass lesions in the right temporal and the left cerebellopontine angle regions. Magnetic resonance imaging exhibited the relationship between the tumors and the surrounding structures. To our knowledge, no case has been reported in which a choroid plexus papilloma originating in the cerebellopontine angle region formed a space-occupying lesion in the right temporal region.
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Affiliation(s)
- H Enomoto
- Department of Neurosurgery, Chukyo Hospital, Nagoya, Japan
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van Swieten JC, Thomeer RT, Vielvoye GJ, Bots GT. Choroid plexus papilloma in the posterior fossa. SURGICAL NEUROLOGY 1987; 28:129-34. [PMID: 3496674 DOI: 10.1016/0090-3019(87)90086-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Choroid plexus papillomas in the posterior fossa can present with different clinical signs and symptoms. The tumors in the patients we discuss in this article originated from different sites of the choroid plexus. One patient, who had a fourth ventricle papilloma, experienced unsteady gait and episodes of dizziness over many years. The tumor was cystic an calcified, and adherent to the brain-stem. The second patient had only signs of increased intracranial pressure. A soft tumor was located in the cerebellomedullary cistern. The third patient, with a papilloma in the cerebellopontine angle, complained of hearing loss. This tumor was firmly adherent to the dura mater and looked exactly like a meningioma. The appearance on computed tomography scan, the macroscopic aspect, and the vascular supply of a papilloma in the posterior fossa can vary considerably.
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Wagle V, Melanson D, Ethier R, Bertrand G, Villemure JG. Choroid plexus papilloma: magnetic resonance, computed tomography, and angiographic observations. SURGICAL NEUROLOGY 1987; 27:466-8. [PMID: 3563861 DOI: 10.1016/0090-3019(87)90255-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Choroid plexus papillomas are rare intracranial neoplasms that are generally benign in nature. They are seen in both children and adults and have a male preponderance. Magnetic resonance imaging, a noninvasive diagnostic tool, demonstrated the intraventricular location and the surrounding anatomy with striking clarity, more effectively than angiography and computed tomography scanning.
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Spallone A, Pastore FS, Hagi Mao M. Choroid plexus papillomas of the cerebellopontine angle in a child. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1986; 7:613-6. [PMID: 3804715 DOI: 10.1007/bf02341477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An 11-year-old girl was admitted with a 3-year history of decreasing hearing, and headache, occasional vomiting and poor school performance of 8 months duration. Neurologically she showed signs of a cerebellopontine angle mass. This was confirmed by CT scan, which showed an enhancing lesion in the right cerebellopontine angle. The lesion was totally removed, with excellent results. Histologically the tumor appeared to be a choroid plexus papilloma. Choroid plexus papillomas of the cerebellopontine angle are extremely rare in children.
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