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Choroid plexus papilloma in children: Diagnostic and surgical considerations
Awadhesh Kumar Jaiswal1, Sushila Jaiswal, Rabi Narayan Sahu
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226 014, India.
Insights
Choroid plexus papilloma (CPP) surgery in children offers excellent outcomes with total excision. Careful surgical techniques minimize bleeding and complications, ensuring symptom relief for most young patients.
Area of Science:
- Pediatric Neurosurgery
- Neurosurgical Oncology
Background:
- Choroid plexus papilloma (CPP) is a benign tumor originating from the ventricular choroid plexus.
- This study focuses on the clinical, radiological, and treatment aspects of CPP in pediatric patients.
Purpose of the Study:
- To review the clinical features, radiological characteristics, and treatment outcomes of pediatric choroid plexus papilloma.
- To evaluate the efficacy and safety of microsurgical excision for CPP in children.
Main Methods:
- A retrospective analysis of seven pediatric patients (≤12 years) with CPP treated over eight years.
- Tumor locations included lateral, IVth, and IIIrd ventricles.
- All patients underwent total microsurgical excision.
Main Results:
- Six out of seven patients experienced complete symptom relief post-surgery.
- One patient died due to postoperative hypokalemia-induced ventricular fibrillation.
- Two patients required CSF diversion procedures for hydrocephalus and subdural collections.
Conclusions:
- Total microsurgical excision of CPP in children is feasible and associated with excellent outcomes.
- Careful surgical techniques, including pedicle management and irrigation, are crucial to minimize bleeding and complications.
- Postoperative management, such as external ventricular drains, aids in preventing complications like hydrocephalus.
Background:
Choroid plexus papilloma (CPP) is a benign neoplasm that arises from the ventricular choroid plexus. The clinical features, radiological characteristics, and treatment have been discussed in this study for a pediatric population.
Methods:
Over an eight-year period, seven pediatric (≤12 years) CPP patients were treated. Tumors were located in the lateral ventricle (n = 4), IVth ventricle (n = 2), and in both the lateral and IIIrd ventricles (n = 1). The patients presented predominantly with features of raised intracranial pressure. Total microsurgical excision was carried out in all cases.
Results:
There was complete relief of symptoms at follow-up in six patients. A 2.5 year-old child with a large trigonal CPP with hydrocephalus leading to complete visual impairment, died due to postoperative hypokalemia that caused ventricular fibrillation. One of our patients required a postoperative, permanent CSF diversion procedure while another required a subduroperitoneal shunt for persisting postoperative subdural CSF collection.
Conclusions:
Coagulation of the tumor under constant irrigation to shrink and excise it in toto, avoids excessive bleeding during surgery. The vascular pedicle supplying the tumor should be adequately dealt with during the last part of tumor removal as retraction of a bleeding pedicle may result in ventricular hemorrhage and brain edema. Following surgery, an external ventricular drain for three days helps in preventing the development of acute hydrocephalus in lateral ventricular lesions, and the color of the drained CSF gives an estimate of the ventricular hemostasis achieved. Total excision is usually possible in these cases with excellent postoperative outcomes.
