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Andour H, Ben El Hend S, Mandour C, Allaoui M, Fikri A. Atypical choroid plexus papilloma: Diagnosis and differentials: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241254000. [PMID: 38764919 PMCID: PMC11102693 DOI: 10.1177/2050313x241254000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/24/2024] [Indexed: 05/21/2024] Open
Abstract
Atypical choroid plexus papilloma is a rare World Health Organization grade 2 intraventricular tumor arising from the epithelium of the plexus choroid with intermediate clinical-pathological features between the benign choroid plexus papilloma and the malignant choroid plexus carcinoma. The main criteria for differentiation are histopathologic, with difficulties in distinguishing it from choroid plexus papilloma based on imaging features. We report the case of a 4-year-old female presenting with headaches and altered mental status. Brain magnetic resonance imaging revealed a right lateral ventricular mass with some atypical characteristics, which were confirmed on pathological examination as an atypical choroid plexus papilloma.
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Affiliation(s)
- H. Andour
- Radiology Department, Military Hospital Mohammed V-Rabat, Rabat, Morocco
| | - S. Ben El Hend
- Radiology Department, Military Hospital Avicennes, Marrakech, Morocco
| | - C. Mandour
- Neurosurgery Department, Military Hospital Mohammed V-Rabat, Rabat, Morocco
| | - M. Allaoui
- Anatomopathology Department, Military Hospital Mohammed V-Rabat, Rabat, Morocco
| | - A. Fikri
- Radiology Department, Military Hospital Avicennes, Marrakech, Morocco
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Zhao R, Fan R, Wan W. Vestibular schwannoma coexisting with dermoid cyst: A case report. Oncol Lett 2024; 27:121. [PMID: 38348385 PMCID: PMC10859835 DOI: 10.3892/ol.2024.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Multiple primary intracranial tumors, or the presence of two or more primary intracranial tumors, are a rare clinical occurrence. The current study presents the case of a 28-year-old patient with concurrent left vestibular schwannoma, left cerebellar hemisphere dermoid cyst and craniovertebral junction malformation, specifically basilar invagination and Klippel-Feil syndrome. The patient exhibited symptoms of torticollis and recurrent headaches, with no apparent hearing loss. A far lateral approach was selected for surgical resection to address these complex conditions and achieve gross total resection in a single-stage surgery while preserving both facial and auditory nerve function. Successful gross total resection was achieved and the function of both nerves was effectively preserved. Of note, the coexistence of vestibular schwannoma and dermoid cyst in the same patient has not been documented in the existing literature. The present study provided a comprehensive account of the presentation and progression of this uncommon medical scenario. Furthermore, a surgical principle for the management of multiple primary intracranial tumors was proposed.
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Affiliation(s)
- Runsheng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
- China National Clinical Research Center for Neurological Diseases, Beijing 100050, P.R. China
| | - Rui Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
- China National Clinical Research Center for Neurological Diseases, Beijing 100050, P.R. China
| | - Weiqing Wan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
- China National Clinical Research Center for Neurological Diseases, Beijing 100050, P.R. China
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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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Gaddi MJS, Lappay JI, Chan KIP, Pascual JSG, Salonga AEM. Pediatric choroid plexus papilloma arising from the cerebellopontine angle: systematic review with illustrative case. Childs Nerv Syst 2021; 37:799-807. [PMID: 32980905 DOI: 10.1007/s00381-020-04896-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Choroid plexus tumors are uncommon intraventricular tumors that develop from the choroid plexus of the central nervous system. Choroid plexus papillomas arising from the cerebellopontine angle have been reported to almost exclusively occur in adults and are rarely found in children. METHODS We report a systematic review conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of SCOPUS and PubMed databases for case reports and case series of choroid plexus papillomas arising in the cerebellopontine angle in the pediatric population and discuss clinical presentation, imaging features, management options, and outcomes. We also report a case managed at our center. RESULTS Ten cases of pediatric choroid plexus papillomas arising in the cerebellopontine angle were identified from the systematic review in addition to the case reported here, resulting in a total of eleven cases. The patients' median age was 8 years with a slight female sex predilection (1.2:1). Patients most commonly presented with headache, cerebellar signs, and cranial nerve palsies with median duration of symptoms at 4 months. All patients underwent surgical treatment with majority achieving gross total excision. No deaths were reported at median follow-up of 12 months. Complete neurologic recovery was attained in seven cases while partial recovery was seen in two cases. CONCLUSION Choroid plexus papillomas found in the cerebellopontine angle in the pediatric population are extremely rare but they should be considered in the differential diagnosis. Complete surgical resection is the mainstay of treatment with excellent outcomes achievable in majority of patients.
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Affiliation(s)
- Mairre James S Gaddi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines.
| | - Jeffrey I Lappay
- Division of Pediatric Neurology, Department of Neurosciences and Pediatrics, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Kevin Ivan P Chan
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Alaric Emmanuel M Salonga
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines
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Adib SD, Hempel JM, Kandilaris K, Grimm F, Zamora RE, Tatagiba M. Surgical management of choroid plexus papilloma of the cerebellopontine and cerebellomedullary angle: classification and strategy. Neurosurg Rev 2021; 44:3387-3397. [PMID: 33629235 PMCID: PMC8592964 DOI: 10.1007/s10143-021-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- S D Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - J M Hempel
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - K Kandilaris
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - F Grimm
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - R Evangelista Zamora
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - M Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Trybula SJ, Karras C, Bowman RM, Alden TD, DiPatri AJ, Tomita T. Infratentorial choroid plexus tumors in children. Childs Nerv Syst 2020; 36:1761-1766. [PMID: 32123998 PMCID: PMC7355280 DOI: 10.1007/s00381-020-04532-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Choroid plexus tumors (CPTs) are rare pediatric intracranial neoplasms, and mostly occur in the lateral ventricle. CPTs located in the infratentorial location are considered to be rare in the pediatric population. We present a series of eight patients treated in the last decade at our institution focusing on clinical presentations and their outcome after excision. METHODS We performed an institutional retrospective review of patients who underwent surgical resection of infratentorial CPTs during the period from 2008 to 2017. Patients' charts were reviewed for demographic data, clinical presentation, surgical treatment, and follow-up. RESULTS There were eight patients (6 females and 2 males), with mean age for the cohort at presentation was 9.0 years. They represent 75% of 12 CPTs of all locations treated at the same period in our institution. These 8 infratentorial CPTs were in the fourth ventricle in seven, and in the cerebellopontine angle (CPA) in one. Seven patients had choroid plexus papillomas (WHO grade I) and 1 had an atypical choroid plexus papilloma (WHO grade II). Gross total resection was attempted in all patients. However, two of 3 patients with fourth ventricle floor invasion had subtotal resection with a thin layer of tumor left on the floor. The remaining 6 had a gross total resection. Six patients with preoperative hydrocephalus had a perioperative external ventricular drainage but none required permanent shunting after tumor resection. None showed recurrence/tumor progression without adjuvant therapy during the follow-up period of 20 months to 11 years. CONCLUSION Infratentorial dominance among pediatric CPTs in this series contradicts previous reports. Infratentorial CPTs are amenable to surgical resection. Unresected small residuals due to invasion to the fourth ventricle floor showed no regrowth during 2 to 3 years follow-up without adjuvant therapy. However, these patients with incomplete resection need watchful observations.
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Affiliation(s)
- S. Joy Trybula
- grid.16753.360000 0001 2299 3507Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL USA
| | - Constantine Karras
- grid.16753.360000 0001 2299 3507Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL USA
| | - Robin M. Bowman
- grid.16753.360000 0001 2299 3507Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL USA
| | - Tord D. Alden
- grid.16753.360000 0001 2299 3507Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL USA
| | - Arthur J. DiPatri
- grid.16753.360000 0001 2299 3507Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL USA
| | - Tadanori Tomita
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL, USA.
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Tayebi Meybodi A, Borba Moreira L, Zhao X, Preul MC, Lawton MT. Anatomical Analysis of the Vagoaccessory Triangle and the Triangles Within: The Suprahypoglossal, Infrahypoglossal, and Hypoglossal–Hypoglossal Triangles. World Neurosurg 2019; 126:e463-e472. [DOI: 10.1016/j.wneu.2019.02.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
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Lin H, Leng X, Qin CH, Du YX, Wang WS, Qiu SJ. Choroid plexus tumours on MRI: similarities and distinctions in different grades. Cancer Imaging 2019; 19:17. [PMID: 30894223 PMCID: PMC6427869 DOI: 10.1186/s40644-019-0200-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background The therapeutic planning varies for different grades of choroid plexus tumours (CPTs). The aim of this study was to define the similarities and distinctions among MRIs for different grades of CPTs, providing more guidance for clinical decisions. Methods We reviewed the MRI findings in 35 patients with CPT verified by surgical pathology, including 18 choroid plexus papillomas (CPPs, grade I), 11 atypical choroid plexus papillomas (aCPPs, grade II), and 6 choroid plexus carcinomas (CPCs, grade III). Nonparametric testing based on ranks was performed to evaluate the association of pathological grade with MRI findings. Results Among the 35 CPTs, 29 were located in the ventricular system. The tumours were generally slightly hypo- or isointense on T1WI, slightly hyper- or isointense on T2WI, and moderately or strongly enhanced in post-contrast imaging. Twenty cases were accompanied by hydrocephalus. The median tumour longest diameters of CPPs, aCPPs, and CPCs were 28.6, 44.6, and 60.6 mm, respectively. Four cases were purely cystic, 6 were papillary, 10 were lobulated, and 2 were irregular. Three cases had necrosis. The median oedema diameters of CPPs, aCPPs, and CPCs were 0, 0, and 24.1 mm, respectively. The grades of CPTs were statistically associated with tumour longest diameter (rs = 0.68, P < 0.001), internal morphology (χ2 = 10.32, P = 0.016), necrosis (Z = 2.27, P = 0.023), and oedema diameter (rs = 0.72, P < 0.001). Conclusion CPTs typically appeared as intraventricular papillary or lobulated lesions, often accompanied by hydrocephalus. Larger tumour, irregular or fuzzy internal morphology, presentation of necrosis and wide-ranging peritumoural oedema might increase the likelihood of malignancy.
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Affiliation(s)
- Huan Lin
- Department of Radiology, Zhujiang Hospital of Southern Medical University, No. 253, Gong Ye Da Dao Zhong, Guangzhou, 510280, People's Republic of China
| | - Xi Leng
- Medical Imaging Center, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16, Ji Chang Lu, Guangzhou, 510405, People's Republic of China
| | - Chun-Hong Qin
- Medical Imaging Center, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16, Ji Chang Lu, Guangzhou, 510405, People's Republic of China
| | - Yong-Xing Du
- Department of Radiology, Shunde Hospital of Southern Medical University, Foshan, People's Republic of China
| | - Wen-Sheng Wang
- Medical Imaging Center, Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Shi-Jun Qiu
- Medical Imaging Center, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16, Ji Chang Lu, Guangzhou, 510405, People's Republic of China.
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Tang C, Bian L, Jiang H, Yin W, Dai D. Choroid plexus papilloma presenting as an occipital mass with neck pain: Case report. Medicine (Baltimore) 2018; 97:e12466. [PMID: 30235739 PMCID: PMC6160022 DOI: 10.1097/md.0000000000012466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Choroid plexus papillomas are rare benign central nervous system neoplasms arising from choroid plexus epithelium. They are most often located in the lateral ventricle, followed by the fourth and third ventricles and, rarely, in the cerebellopontine angle. PATIENT CONCERNS We report an uncommon case of a 17-year-old boy who presented with neck pain that had lasted for more than 1 month, with accompanying pain and numbness in his upper extremities. His conditions included slight dizziness, nausea, diplopia, paresthesia, and an unsteady gait. Magnetic resonance imaging (MRI) showed huge cerebellopontine angle tumor that extended to the front medulla oblongata. DIAGNOSIS Choroid plexus papilloma (WHO I) was diagnosed in this patient. INTERVENTIONS The patient was referred for neurosurgical intervention. The very large neoplasm was subtotally resected. OUTCOMES The symptoms of the patient were gradually alleviated after surgery and subsequent radiotherapy treatment, but unfortunately, follow-up of 2 years later revealed that the disease was recurrent and the young man passed away. LESSONS Neck pain is related to many factors. The case provided an awareness of the origin of severe intracranial disease. It is mandatory to take a thorough clinical assessment with a holistic approach.
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Affiliation(s)
- Chunlin Tang
- Department of Physical Medicine and Rehabilitation
| | - Lianlong Bian
- Department of Radiology, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan City, Jiangsu Province, China
| | - Hao Jiang
- Department of Physical Medicine and Rehabilitation
| | - Wenyan Yin
- Department of Physical Medicine and Rehabilitation
| | - Dechun Dai
- Department of Physical Medicine and Rehabilitation
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Morphometry and microsurgical anatomy of Bochdalek's flower basket and the related structures of the cerebellopontine angle. Acta Neurochir (Wien) 2017; 159:1539-1545. [PMID: 28584917 DOI: 10.1007/s00701-017-3234-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bochdalek's flower basket (Bfb) is the distal part of the horizontal segment of the fourth ventricle's choroid plexus protruding through the lateral aperture (foramen of Luschka). The microsurgical anatomy of the cerebellopontine angle, fourth ventricle and its inner choroid plexus is well described in the literature, but only one radiological study has investigated the Bfb so far. The goal of the present study was to give an extensive morphometric analysis of the Bfb for the first time and discuss the surgically relevant anatomical aspects. METHOD Forty-two formalin-fixed human brains (84 cerebellopontine angles) were involved in this study. Photomicrographs with scale bars were taken in every step of dissection to perform further measurements with Fiji software. The lengths and widths of the Bfb, rhomboid lip and lateral aperture of the fourth ventricle as well as the related neurovascular and arachnoid structures were measured. The areas of two sides were compared with paired t-tests using R software. Significance level was set at p < 0.05. RESULTS Protruding choroid plexus was present in 77 cases (91.66%). In 6 cases (7.14%), the Bfb was totally covered by the rhomboid lip, and in one case (1.19%), it was absent. The mean width of the Bfb was 6.618 mm (2-14 mm), the mean height 5.658 mm (1.5-14 mm) and mean area 25.80 mm2 (3.07-109.83 mm2). There was no statistically significant difference between the two sides (p = 0.1744). The Bfb was in contact with 20 AICAs (23.80%), 6 PICAs (7.14%) and 39 vestibulocochlear nerves (46.42%). Arachnoid trabecules, connecting the lower cranial nerves to the Bfb or rhomboid lip, were found in 57 cases (67.85%). CONCLUSIONS The Bfb is an important landmark during various surgical procedures. Detailed morphology, dimensions and relations to the surrounding neurovascular structures are described in this study. These data are essential for surgeons operating in this region.
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