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Mangham WM, Elijovich L, Lee-Diaz JA, Orr BA, Gienapp AJ, Boop FA. Pre-operative embolization for staged treatment of infantile choroid plexus papilloma. Childs Nerv Syst 2022; 38:429-433. [PMID: 34009420 DOI: 10.1007/s00381-021-05212-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
Choroid plexus papillomas (CPPs) are benign but rare neuroepithelial neoplasms of the choroid plexus that represent the non-malignant form of a spectrum of tumors of the choroid plexus. The vast majority of CPPs present in children under 5 years of age. Some CPPs are diagnosed prenatally, but many of them reach a large size before diagnosis. CPPs typically present with signs and symptoms of hydrocephalus. Treatment of these tumors has traditionally been with surgical resection. Large CPPs in young children present a challenge due to risk of high blood loss during resection. Here, the authors describe the case of a 3-month-old presenting with hydrocephalus and a large CPP of the third ventricle that was managed with a staged strategy of embolization followed by a delayed resection, allowing the tumor to involute prior to surgery.
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Affiliation(s)
- William M Mangham
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Semmes Murphey Clinic, Memphis, TN, USA
| | - Jorge A Lee-Diaz
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Brent A Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA. .,Semmes Murphey Clinic, Memphis, TN, USA. .,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
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Perinatal (fetal and neonatal) choroid plexus tumors: a review. Childs Nerv Syst 2019; 35:937-944. [PMID: 30953158 DOI: 10.1007/s00381-019-04135-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/20/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The object of this review is to describe the choroid plexus tumors (CPTs) occurring in the fetus and neonate with regard to clinical presentation, location, pathology, treatment, and outcome. MATERIALS AND METHODS Case histories and clinical outcomes were reviewed from 93 cases of fetal and neonatal tumors obtained from the literature and our own institutional experience from 1980 to 2016. RESULTS Choroid plexus papilloma (CPP) is the most common tumor followed by choroid plexus carcinoma (CPC) and atypical choroid plexus papilloma (ACPP). Hydrocephalus and macrocephaly are the presenting features for all three tumors. The lateral ventricles are the main site of tumor origin followed by the third and fourth ventricles, respectively. CPTs of the fetus are detected most often near the end of the third trimester of pregnancy by fetal ultrasound. The extent of surgical resection plays an important role in the treatment and outcome. In spite of excellent survival, which is especially true in the case of CPP, surgical resection may carry significant risks in an immature baby. Given the neonatal low blood volume and increased vascularity of the tumors, there is potential risk for hemorrhage. Although advances in neurosurgical techniques have led to a greater degree of complete surgical resections, survival for the perinatal CPC group remains low even with multimodality therapies. CONCLUSION Perinatal CPTs have variable overall survivals depending on degree of surgical resection and tumor biology. An increased understanding of the molecular features of these tumors may lead to improved therapies and ultimately survival.
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Mizowaki T, Nagashima T, Yamamoto K, Kawamura A, Yoshida M, Kohmura E. Optimized surgical approach to third ventricular choroid plexus papillomas of young children based on anatomical variations. World Neurosurg 2013; 82:912.e15-9. [PMID: 23510722 DOI: 10.1016/j.wneu.2013.03.011] [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: 10/11/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Choroid plexus papilloma (CPP) in the third ventricle is a rare benign intracranial tumor. METHODS We report 3 pediatric cases of CPP in the third ventricle. The lesions were totally removed by a different surgical approach in each case. RESULTS When remarkable hydrocephalus is present, the transcortical approach is easier to perform, but may expose the patient to epilepsy and subdural effusion postoperatively. The transcallosal approach offers direct exposure of the ventricle system with minimal risk of cortical damage. The transcallosal-transforaminal approach with posterior enlargement of the foramen of Monro along the choroidal fissure provides a direct trajectory into the third ventricle through the natural cleft. The transcallosal-interforniceal approach does not depend on the size of the foramen of Monro, but it carries a risk for damage to the both fornices. The midline plane of the septum pellucidum and the forniceal columns in children are sometimes easily identifiable and separable, and in such cases the transcallosal-interforniceal approach appears to be a safe route for tumors extending to the posterior third ventricle. The interforniceal approach should be reserved for lesions that cannot be removed safely via the transforaminal approach. CONCLUSIONS Young children have a small total blood volume and fragile cardiovascular status. Therefore, it is critical to preserve the venous system and to ligate the feeding artery before extirpation of the tumor. The surgical approach to the third ventricular CPPs should be tailored to individual children based on tumor size, location, and vascularity.
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Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
| | - Tatsuya Nagashima
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kazuki Yamamoto
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Atsufumi Kawamura
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Makiko Yoshida
- Department of Pathology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University School of Medicine, Kobe, Japan
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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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Wind JJ, Bell RS, Bank WO, Myseros JS. Treatment of third ventricular choroid plexus papilloma in an infant with embolization alone. J Neurosurg Pediatr 2010; 6:579-82. [PMID: 21121734 DOI: 10.3171/2010.9.peds1039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a 3-month-old boy with a third ventricular tumor consistent with a choroid plexus papilloma. This child presented with macrocephaly, irritability, inability to roll over, and vomiting. He was found to have an enlarged head circumference, a full and tense fontanel, splayed sutures, and forced downward gaze. Imaging revealed severe ventriculomegaly and a brightly enhancing third ventricular lesion consistent with papilloma. Treatment planning included placement of a ventriculoperitoneal shunt to treat hydrocephalus and to allow the child to grow prior to resection. Due to the vascular nature of these tumors and the age of this child, the tumor was embolized with a plan for eventual resection; however, embolization resulted in involution and total regression of the tumor. There is no residual disease at last follow-up of 16 months. In this specific scenario of a choroid plexus papilloma in an infant, when operative intervention may be technically difficult and associated with significant morbidity, embolization with close observation may be a valid treatment option. If used, the patient would need to be closely followed for evidence of residual or recurrent disease, which would require operative intervention.
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Affiliation(s)
- Joshua J Wind
- Department of Neurological Surgery, The George Washington University, Washington, DC, USA
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Piastra M, Di Rocco C, Tempera A, Caresta E, Zorzi G, Tosi F, Massimi L, Pietrini D. Massive blood transfusion in choroid plexus tumor surgery: 10-years' experience. J Clin Anesth 2007; 19:192-7. [PMID: 17531727 DOI: 10.1016/j.jclinane.2006.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 09/20/2006] [Accepted: 10/08/2006] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To describe our 10 years of experience with childhood choroid plexus tumors (CPTs). DESIGN Retrospective chart analysis. SETTING Operating room and pediatric intensive care unit (PICU) of a university hospital. PATIENTS 18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months. MEASUREMENTS Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters. RESULTS Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 +/- 1.79% vs 0.20 +/- 0.17% [P < 0.01] and 1.50 +/- 1.86% vs 0.29 +/- 0.21% [P < 0.01] on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 +/- 28.06 vs 27.57 +/- 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment. CONCLUSION Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University School of Medicine, Gemelli Hospital, 00168 Rome, Italy.
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Pietrini D, Zanghi F, Pusateri A, Tosi F, Pulitanò S, Piastra M. Anesthesiological and intensive care considerations in children undergoing extensive cerebral excision procedure for congenital epileptogenic lesions. Childs Nerv Syst 2006; 22:844-51. [PMID: 16807725 DOI: 10.1007/s00381-006-0153-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Epilepsy is a relatively common condition in childhood with a generally favorable prognosis of the affected population. Nevertheless, a significant minority of the treated children do not respond to the medical treatment so that surgical treatment is necessary. While minor surgical procedures have a negligible incidence of mortality, major ones may carry a significant risk of perioperative complications. The leading cause of mortality is represented by hemorrhagic derangements after high intraoperative and postoperative blood loss, mostly in very young patients. Therefore, restoration of euvolemia, detection and correction of related bleeding disorders represent the major concern for pediatric neuroanesthesiologists and intensivists throughout the perioperative period. The present report is focused on the anesthesia and intensive care management of the surgical epileptic patient. CONCLUSION Authors recommend that these high-risk procedures should be performed in highly experienced centers where pediatric neurosurgery is performed daily.
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Affiliation(s)
- D Pietrini
- Department of Anesthesiology and Intensive Care, Catholic University Medical School, Largo A. Gemelli, 1, 00168, Rome, Italy
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