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Kankane VK, Warade AC, Misra BK. Nonvestibular Schwannoma Tumors in the Cerebellopontine Angle: A Single-Surgeon Experience. Asian J Neurosurg 2019; 14:154-161. [PMID: 30937027 PMCID: PMC6417343 DOI: 10.4103/ajns.ajns_335_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma. Schwannomas account for 8.5% of all intracranial tumors and more than 90% of the tumors originate from the eighth cranial nerve, but one in five CPA tumors are not vestibular schwannoma. These tumors may have different manifestations and require different management strategies. Methods: We report 224 consecutive NVCPAT operated in the Department of Neurosurgery, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, by the senior author between 2001 and 2014 and discuss the different approaches and outcomes in NVCPAT. Results: The age range was 20–60 years and there were 129 females and 95 male patients. The clinical material consisted of 81 cases of meningioma (36.1%), 44 cases of epidermoid (19.64%), 34 cases of trigeminal schwannoma (15.17%), 26 cases of jugular foramen schwannoma (11.60%), and 39 cases of other tumors (17.41%). In nonvestibular schwannoma (NVS), symptoms and signs from cranial nerve VIII are less frequent and other cranial nerves and cerebellar symptoms and signs predominate. Conclusion: Symptoms and signs are different in NVCPAT from those found in patients with vestibular schwannoma. Hearing loss is not the predominant symptoms. Cerebellar signs and trigeminal dysfunction are more common. The most common approach used in the current series was retrosigmoid craniotomy. Gamma knife radiosurgery was a useful adjunct in a subset of these patients.
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Affiliation(s)
- Vivek Kumar Kankane
- P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - Basant Kumar Misra
- Department of Neurosurgery and Gammaknife Radiosurgery, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Muñoz Montoya JE, Maldonado Moran MA, Santamaria Rodriguez P, Toro Lopez S, Perez Cataño CS, Luque Suarez JC. Choroid Plexus Papilloma of the Fourth Ventricle: A Pediatric Patient. Asian J Neurosurg 2019; 14:585-588. [PMID: 31143290 PMCID: PMC6516030 DOI: 10.4103/ajns.ajns_301_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Choroid plexus papilloma is a low-frequency entity in both the adult and pediatric populations. Its clinical presentation is very variable as it depends on its location and length. We must always do the differential diagnosis between papilloma and other intraventricular pathologies. This article is about a case report of a pediatric patient with a Choroid plexus papilloma located in the fourth ventricle, a location that is atypical for the pediatric population.
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Affiliation(s)
| | | | | | - Sebastian Toro Lopez
- Departament of Neurosurgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | - Juan Carlos Luque Suarez
- Neurosurgeon, Departament of Neurosurgery, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá, Colombia
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3
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Mohanty S, Rout SS, Sarangi GS, Devi K. Choroid Plexus Papilloma Arising From the Temporal Horn With a Bilateral Hypersecretory Hydrocephalus: A Case Report and Review of Literature. World J Oncol 2016; 7:51-56. [PMID: 28983364 PMCID: PMC5624697 DOI: 10.14740/wjon967w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Cerebrospinal fluid (CSF) within the cerebral ventricular system is secreted by a neuroepithelial tissue which is called as the choroid plexus. Tumors arising from these tissues are rare. Choroid plexus papillomas (CPPs) have been denoted as WHO grade I of the choroid plexus tumors. Among the intracranial tumors, neoplasms of the choroid plexus constitute around 0.36-0.6%. CPPs are mostly slow growing and cause symptoms due to mass effect and obstructive hydrocephalus, resulting in increased intracranial pressure. We report a case of CPP arising from the temporal horn in a 7-year-old girl presenting with progressive head enlargement since birth due to bilateral massive hydrocephalus without any obstruction, making it purely a hypersecretory hydrocephalus. A drainage procedure followed by complete tumor resection was carried out in our case and the patient showed marked relief from her symptoms.
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Affiliation(s)
- Sureswar Mohanty
- Department of Neurosurgery, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Kalinga nagar, Bhubaneswar 751003, Odisha, India
| | - Suman Saurav Rout
- Department of General Surgery, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Kalinga nagar, Bhubaneswar 751003, Odisha, India
| | - Gouri Sankar Sarangi
- Department of Neurosurgery, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Kalinga nagar, Bhubaneswar 751003, Odisha, India
| | - Kumudini Devi
- Department of Pathology, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Kalinga nagar, Bhubaneswar 751003, Odisha, India
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Kulwin C, Chan D, Ting J, Hattab EM, Cohen-Gadol AA. Endoscopic endonasal transplanum transtuberculum resection of a large solid choroid plexus papilloma of the third ventricle. J Clin Neurosci 2013; 21:1263-6. [PMID: 24480582 DOI: 10.1016/j.jocn.2013.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022]
Abstract
Choroid plexus papilloma (CPP) is a highly vascular solid or mixed solid-cystic tumor. Previously described resection techniques for the more common solid CPP in the third ventricle have all been through the transcranial route. The authors review the literature and describe a patient who, to their knowledge, is the first successful resection of a large, completely solid CPP of the third ventricle through an entirely endoscopic, extended transphenoidal approach. Using modern neuroendoscopic methods and closure techniques, a gross total resection was accomplished and a successful closure without postoperative cerebrospinal fluid leak was achieved despite the presence of preoperative hydrocephalus. For appropriately selected lesions, an extended endonasal skull base resection can be performed successfully for vascular tumors despite the presence of preoperative hydrocephalus.
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Affiliation(s)
- Charles Kulwin
- Indiana University, Department of Neurological Surgery and Goodman Campbell Brain and Spine, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA
| | - David Chan
- Indiana University, Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Jonathan Ting
- Indiana University, Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Eyas M Hattab
- Indiana University, Department of Pathology and Laboratory Medicine, Indianapolis, IN, USA
| | - Aaron A Cohen-Gadol
- Indiana University, Department of Neurological Surgery and Goodman Campbell Brain and Spine, 355 W. 16th Street, Suite 5100, Indianapolis, IN 46202, USA.
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5
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Endoscopic removal of a cystic choroid plexus papilloma of the third ventricle: A case report and review of the literature. Clin Neurol Neurosurg 2011; 113:582-5. [DOI: 10.1016/j.clineuro.2011.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 02/11/2011] [Accepted: 02/12/2011] [Indexed: 11/21/2022]
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6
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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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7
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Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base 2011; 18:217-27. [PMID: 19119337 DOI: 10.1055/s-2007-1016959] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma, but one in five CPA tumors are not vestibular schwannomas. These tumors may require different management strategies. Compared with vestibular schwannomas, symptoms and signs from cranial nerve VIII are less frequent: other cranial nerve and cerebellar symptoms and signs predominate in patients with these less common CPA tumors. Computed tomography and magnetic resonance imaging often show features leading to the correct diagnosis. Treatment most often includes surgery, but a policy of observation or subtotal resection is often wiser. This review provides a structured approach to the diagnosis of nonvestibular schwannoma CPA lesions and also management guidelines.
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8
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Abeloos L, Massager N. Ectopic choroid plexus associated with trigeminal neuralgia: case report. Acta Neurochir (Wien) 2010; 152:717-9. [PMID: 19688290 DOI: 10.1007/s00701-009-0488-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 11/20/2008] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A 55-year-old man underwent a microvascular decompression procedure for a pharmacoresistant trigeminal neuralgia. Preoperative MRI showed a neurovascular conflict between the Vth nerve root and the superior cerebellar artery. METHODS Dissection of the intracisternal trigeminal root was undertaken, and a piece of Teflon was positioned between the artery and the nerve. RESULTS Choroid plexus was found squeezing the root entry zone of the Vth nerve and partially removed. The patient did not improve after the vascular decompression procedure. Trigeminal neuralgia could be due to a mechanical irritation of the intracisternal nerve root. CONCLUSION Since vascular decompression of the trigeminal root did not relieve the pain, we suggest that the presence of choroid plexus at the root entry zone of the nerve may have induced trigeminal neuralgia in this patient.
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Affiliation(s)
- Laurence Abeloos
- Departement of Neurosurgery, Hôpital ERASME, Université Libre de Bruxelles, 1070 Brussels, Belgium.
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9
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Gamma knife radiosurgery for treatment resistant choroid plexus papillomas. J Neurooncol 2008; 90:105-10. [DOI: 10.1007/s11060-008-9639-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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10
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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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11
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Koeller KK, Sandberg GD. From the archives of the AFIP. Cerebral intraventricular neoplasms: radiologic-pathologic correlation. Radiographics 2002; 22:1473-505. [PMID: 12432118 DOI: 10.1148/rg.226025118] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intraventricular neoplasms are readily seen on cross-sectional images, but the myriad possibilities may make a focused differential diagnosis elusive. Consideration of the tissue within and composing the ventricular lining and the clinical findings provide the means to limit the differential diagnosis when analyzing an intraventricular mass on an imaging study. Ependymomas are typically calcified, are more common in children, are more common in the fourth ventricle, and show intense enhancement on contrast-enhanced images. Subependymomas and central neurocytomas have an affinity for the anterior portion of the lateral ventricle, and both commonly demonstrate a heterogeneous cystic appearance on cross-sectional images. Subependymomas are more common in older adults, whereas central neurocytomas are more common before 40 years of age. Subependymal giant cell astrocytomas always lie near the foramen of Monro and are characterized by frequent calcification, intense enhancement on contrast-enhanced studies, and the presence of other stigmata seen in tuberous sclerosis. When a mass is centered on the choroid plexus, a highly vascular tumor-either choroid plexus papilloma, choroid plexus carcinoma, meningioma, or metastasis-should be suspected. The characteristic heavily lobulated appearance of a choroid plexus tumor favors this diagnosis over other possibilities, although it is not always possible to distinguish between the more common benign form, the choroid plexus papilloma, and the less common malignant counterpart, the choroid plexus carcinoma. By using clinical, demographic, and imaging findings, one can significantly limit the differential diagnosis for many of the most common intraventricular neoplasms.
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Affiliation(s)
- Kelly K Koeller
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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12
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Chroni E, Paschalis C, Konstantinou D, Maraziotis T, Bonas M, Papapetropoulos T. Segmental myoclonus as the sole manifestation of a choroid plexus papilloma in the posterior fossa. Case report. J Neurosurg 2001; 95:338-40. [PMID: 11780907 DOI: 10.3171/jns.2001.95.2.0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a 22-year-old woman with involuntary contractions of the sternocleidomastoid and trapezius muscles that resulted in turning movements of the head. The jerks displayed the clinical and neurophysiological characteristics of segmental myoclonus (SM) restricted to muscles supplied bilaterally by the first four cervical segments. Magnetic resonance imaging disclosed a tumor in the midline above the cisterna magna that was later histologically proven to be a choroid plexus papilloma. The patient's involuntary movements did not extend to other muscle groups or, in particular, to the palate, as one might have expected in the case of brainstem lesions. Myoclonus was the sole clinical manifestation of the tumor in this patient; other signs and symptoms invariably reported in other cases of posterior fossa papilloma, such as increased intracranial pressure or cranial nerve palsies, were absent. Release from suprasegmental control is suggested as a possible pathophysiological mechanism in this case of SM.
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Affiliation(s)
- E Chroni
- Department of Neurology, University Hospital of Patras, Greece
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13
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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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15
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Leblanc R, Bekhor S, Melanson D, Carpenter S. Diffuse craniospinal seeding from a benign fourth ventricle choroid plexus papilloma. Case report. J Neurosurg 1998; 88:757-60. [PMID: 9525724 DOI: 10.3171/jns.1998.88.4.0757] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Choroid plexus papillomas can metastasize to the subarachnoid space, but extensive metastasis has only been reported when the tumors are malignant. The authors report a case of diffuse, extensive metastasis to the craniospinal leptomeninges from a benign fourth ventricular choroid plexus papilloma in an adult. This 19-year-old woman presented with a 2-year history of headache, blurred vision, diplopia, and ataxia. Magnetic resonance imaging of the brain and spinal cord revealed obstructive hydrocephalus caused by a 4-cm, partially calcified, inhomogeneously enhancing tumor of the fourth ventricle that was displacing the pons, medulla oblongata, and cerebellum. Innumerable cystic lesions of varying size were also seen in the cranial and spinal leptomeninges. Histological examination of the resected fourth ventricular tumor and of a few of the leptomeningeal lesions revealed a benign choroid plexus papilloma and leptomeningeal choroid plexus cysts. This singular case of diffuse and extensive metastasis to the craniospinal leptomeninges from a histologically benign fourth ventricular papilloma adds to the available information about the biological potential of these tumors and expands the differential diagnosis of posterior fossa lesions with subarachnoid metastasis.
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Affiliation(s)
- R Leblanc
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University, Quebec, Canada
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Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, Kalifa C, Brunelle F, Sgouros S, Meyer P, Cinalli G, Zerah M, Pierre-Kahn A, Renier D. Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 1998; 88:521-8. [PMID: 9488307 DOI: 10.3171/jns.1998.88.3.0521] [Citation(s) in RCA: 171] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECT Choroid plexus tumors are rare intraventricular tumors (1% of all intracranial tumors) that occur mainly in children. The pathophysiological characteristics of associated hydrocephalus, surgical management, and oncological issues related to these tumors remain a matter of debate. To understand more about these tumors, the authors have reviewed their experience with the management of 38 children with choroid plexus tumors. METHODS There were 25 cases of papilloma and 13 of carcinoma. The mean age of the patients at presentation was 22.5 months, and one-half of the patients were younger than 2 years of age. Hydrocephalus was present in 33 patients and poorly correlated with the size, site, and pathological characteristics of the tumor. In nine children, a ventriculoperitoneal shunt was required after tumor excision, calling into question the notion that cerebrospinal fluid oversecretion is the only cause of hydrocephalus. Complete excision was achieved in 96% of the cases of papilloma and 61.5% of the cases of carcinoma. These surgical procedures were complicated by the risks of intraoperative hemorrhage, which proved to be fatal in two cases, and postoperative brain collapse, which led to subdural fluid collections requiring subdural shunt placement in six patients. Preoperative embolization was partially successful in four cases and significantly assisted surgery. Preoperative controlled drainage of excessively dilated ventricles and intraoperative gluing of the cortical incision have been used to address the problem of postoperative brain collapse. Patients with carcinomas were treated postoperatively by chemotherapy alone (seven cases), radiotherapy (one case), or chemotherapy plus radiotherapy (one case). The overall 5-year survival rate was 100% for patients with papillomas and 40% for those with carcinomas. CONCLUSIONS Total surgical excision is curative in cases of papillomas. For carcinomas, the most effective treatment remains total surgical excision; however, adjuvant treatment in the form of chemotherapy in patients younger than age 3 years, supplemented by radiation therapy in older children, can moderately reduce the risk of recurrence.
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Affiliation(s)
- P Pencalet
- Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
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Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, Kalifa C, Brunelle F, Sgouros S, Meyer P, Cinalli G, Zerah M, Pierre-Kahn A, Renier D. Papillomas and carcinomas of the choroid plexus in children. Neurosurg Focus 1998. [DOI: 10.3171/foc.1998.4.1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Choroid plexus tumors are rare intraventricular tumors (1% of all intracranial tumors) that occur mainly in children. The physiopathological characteristics of associated hydrocephalus, surgical management, and oncological issues related to these tumors remain a matter of debate. To understand more about these tumors, the authors have reviewed their experience with the management of 38 children with choroid plexus tumors.
Methods
There were 25 cases of papilloma and 13 of carcinoma. The mean age of the patients at presentation was 22.5 months and one-half of the patients were younger than 2 years of age. Hydrocephalus was present in 33 patients and poorly correlated with the size, site, and pathological characteristics of the tumor. In nine children, a ventriculoperitoneal shunt was required after tumor excision, calling into question the notion that cerebrospinal fluid oversecretion is the only cause of hydrocephalus.
Complete excision was achieved in 96% of the cases of papilloma and 61.5% of the cases of carcinoma. These surgical procedures were complicated by the risks of perioperative hemorrhage, which proved to be fatal in two cases, and postoperative brain collapse, which led to subdural fluid collections requiring subdural shunt placement in six patients. Preoperative embolization was partially successful in four cases and significantly assisted surgery. Preoperative controlled drainage of excessively dilated ventricles and intraoperative gluing of the cortical incision have been used to address the problem of postoperative brain collapse.
Patients with carcinomas were treated postoperatively by chemotherapy alone (seven cases), radiotherapy (one case), or chemotherapy plus radiotherapy (one case). The overall 5-year survival rate was 100% for patients with papillomas and 40% for those with carcinomas.
Conclusions
Total surgical excision is curative in cases of papillomas. For carcinomas, the most effective treatment remains total surgical excision; however, adjuvant treatment in the form of chemotherapy in patients younger than 3 years, supplemented by radiation therapy in older children, can moderately reduce the risk of recurrence.
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Abstract
Choroid plexus papillomas (CPPs) are rare neoplasms accounting for less than 1% of all intracranial tumours. We present our experience with 13 consecutive cases managed by us between 1981 and 1991. There were eight children and five adults. Five patients had tumours in the 4th ventricle, four in lateral ventricle, one in the 3rd ventricle, two in the cerebellomedullary cistern and one in the cerebellopontine angle. The cerebellomedullary cistern is a rare site for CPPs. Although the 4th ventricle remains the common site for adult CPPs, in our series there was a higher incidence of posterior fossa papillomas even in children. Only six patients out of 13 underwent precraniotomy shunts. All patients had their tumours operated upon and verified histologically. Total excision of the tumour could be achieved in nine patients; only a sub total excision was possible in the remaining four. There were two surgical mortalities in the earlier part of this series. Two patients with subtotal excisions underwent radiation therapy; one of these had regrowth of the tumour and another was lost to follow up. The other nine patients are doing well with a follow-up ranging from 9 to 90 months. Surgical resection with the objective of achieving total excision should be attempted in these tumours.
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Affiliation(s)
- R Sharma
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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19
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Lalwani AK. Meningiomas, Epidermoids, And Other Nonacoustic Tumors Of The Cerebellopontine Angle. Otolaryngol Clin North Am 1992. [DOI: 10.1016/s0030-6665(20)30970-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ho DM, Wong TT, Liu HC. Choroid plexus tumors in childhood. Histopathologic study and clinico-pathological correlation. Childs Nerv Syst 1991; 7:437-41. [PMID: 1790527 DOI: 10.1007/bf00263185] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Choroid plexus tumors are rare and account for only 2.3% (8/352) of primary childhood intracranial neoplasms in our series. Most of our patients were under 2 years of age. The tumors had a predilection for the lateral ventricle. Calcification was found in half of these tumors, and ossification was seen in 1 case. Histological features of malignancy including invasion, loss of differentiation, and severe nuclear pleomorphism pointed to a poor prognosis. Such features were found in 2 cases. Neither a large number of mitoses nor necrosis was a constant feature in cases of malignancy. Transthyretin, a marker for choroid plexus tumors, was positive in all cases. However, negative S-100 or positive carcinoembryonic antigen was not necessarily associated with a more aggressive histological pattern. All the papillomas could be totally resected without recurrence, and all the patients with carcinoma died within a few months.
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Affiliation(s)
- D M Ho
- Department of Pathology, Veterans General Hospital-Taipei, Republic of China
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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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