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Embolization of a pediatric choroid plexus papilloma as a stand-alone treatment strategy: illustrative case
Lucas P Mitre1, Ishav Y Shukla1, Bradley Weprin1
1Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas.
Insights
Embolization of pediatric choroid plexus papilloma (CPP) can be definitive management, not just preoperative. This rare case highlights embolization as a potential standalone strategy for CPP in select pediatric patients, requiring long-term monitoring.
Area of Science:
- Pediatric Neurosurgery
- Interventional Neuroradiology
- Pediatric Oncology
Background:
- Choroid plexus papilloma (CPP) is a rare pediatric brain tumor.
- Surgical resection is the standard treatment for CPP.
- This case explores embolization as a primary treatment.
Purpose of the Study:
- To report a rare case of pediatric choroid plexus papilloma treated with embolization.
- To evaluate the efficacy of embolization as definitive management for CPP.
- To discuss the feasibility of non-surgical management for selected CPP cases.
Main Methods:
- A 14-month-old boy with suspected CPP underwent diagnostic cerebral angiography.
- Endovascular embolization with Onyx-18 was performed, achieving complete devascularization.
- Serial imaging and clinical follow-up were conducted.
Main Results:
- Complete angiographic devascularization was achieved without complications.
- Serial imaging showed progressive lesion size and enhancement decrease.
- The patient remained neurologically stable with a stable residual lesion.
Conclusions:
- Stand-alone embolization may be a feasible definitive strategy for select pediatric CPP cases.
- Close long-term surveillance is crucial for patients treated with embolization.
- This approach offers an alternative to immediate resection in specific circumstances.
Background:
In this case report, the authors describe a rare case in which embolization of a pediatric choroid plexus papilloma (CPP) functioned as definitive management rather than a preoperative complement.
Observations:
A 14-month-old boy underwent evaluation for macrocephaly and developmental delay and was found to have a 2.6-cm avidly enhancing intraventricular mass centered in the temporal horn of the left lateral ventricle with extension into the atrium, radiographically most consistent with CPP. Diagnostic cerebral angiography demonstrated predominant supply from the left anterior choroidal artery. The lesion underwent endovascular embolization with Onyx-18, achieving complete angiographic devascularization without procedural complication. Planned resection was initially deferred because of intercurrent rhinovirus/enterovirus infection in the acute postprocedural period and the favorable embolization result. Serial follow-up imaging demonstrated a progressive decrease in lesion size and enhancement, followed by radiographic stability of a small treated residual lesion without evidence of dissemination or new complication. The patient remained neurologically stable throughout follow-up.
Lessons:
Although resection remains the standard treatment for CPP, stand-alone embolization may represent a feasible strategy in highly selected circumstances, provided that close long-term surveillance is maintained. https://thejns.org/doi/10.3171/CASE26348.
