Endoscopic Assisted Microsurgical Resection of Lateral Ventricular Choroid Plexus Papillomas in Children

Background: Choroid plexus tumors arise mainly in children. Their blood supply is from the choroidal arteries in the form of a pedicle. These tumors represent surgical challenge owing to their vascularity and the relatively low blood volume especially in infants, necessitating early control of the vascular pedicle. Endoscopic assisted microsurgery had proven beneficial in resecting many intra-ventricular masses. Objective: The aim of this study was to evaluate the endoscopic assisted microsurgical resection of choroid plexus papillomas focusing on clinical outcome, extent of resection, the extent of cortical incision and the need for brain retraction. Patients and Methods: Sixteen choroid plexus papillomas in fifteen children with widely dilated ventricles were operated upon between 2007 and 2014. All cases had an initial atiempt of endoscopic coagulation and detachment of the vascular pedicle followed by microsurgical excision of the mass. The extent of the cortical incision and the need to use self-retaining brain retractors were documented. Clinical outcome was assessed in the early postoperative period and after one month. Magnetic resonance imaging was performed three months postoperatively for all patients. Results: Endoscopic coagulation and detachment was achieved completely in fourteen tumors and partially in one tumor. Failure of coagulation in the remaining tumor was due to its huge size and failure to mobilize it. Total excision was achieved in all cases. Two patients developed transient weakness and one patient developed postoperative seizures. Hydrocephalus needed insertion of a ventriculo-peritoneal shunt in twelve patients. Smaller cortical incisions were performed and no self-retaining brain retractors were needed in cases with complete endoscopic coagulation. Conclusion: Endoscopic coagulation and detachment of the vascular pedicle followed by microsurgical resection of choroid plexus papillomas provides adequate and safe tumor resection with smaller cortical incisions and minimal brain retraction.