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  • Superior Parietal Lobule Approach for Choroid Plexus Papillomas Without Pre-operative Embolization in Very Young Children

    Final Number:

    Benjamin C. Kennedy MD, BA; Michael Brendan Cloney BA; Richard C. E. Anderson MD; Neil Feldstein MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Choroid plexus papillomas are rare neoplasms often found in the atrium of the lateral ventricle of infants that cause overproduction hydrocephalus. The extensive vascularity and medially located blood supply of these tumors, coupled with the young age of the patients, can make blood loss challenging. Pre-operative embolization has been advocated to reduce blood loss and prevent the need for transfusion, but this mandates radiation exposure and the additional risks of vessel injury and stroke.

    Methods: We conducted a retrospective review of all children who presented to Columbia University/Morgan Stanley Children’s Hospital of New York with a choroid plexus papilloma in the atrium of the lateral ventricle that underwent surgery using a superior parietal lobule approach without pre-operative embolization.

    Results: Nine children were included with a median age of seven months. There were no perioperative complications or new neurological deficits. All patients had intraoperative blood loss of less than 100cc with a mean minimum hematocrit of 26.9 (range 19.6-36.2). No patients required a blood transfusion. Median follow-up was 50 months, during which time no patients demonstrated residual or recurrent tumor on MRI, nor did any have an increase in ventricular size or require CSF diversion.

    Conclusions: The superior parietal lobule approach is a safe and effective approach for very young children with choroid plexus papillomas in the atrium of the lateral ventricle. Our results suggest that preoperative embolization is not essential to avoid transfusion or achieve overall good outcomes in these patients. This management strategy avoids radiation exposure and the additional risks associated with embolization.

    Patient Care: Very young patients undergoing surgery for choroid plexus papillomas can potentially suffer from substantial blood loss with resultant transfusions, and can have vascular damage or stroke from pre-operative embolization. In this study, we demonstrate the advantages of a very safe and effective management strategy for these tumors to prevent the above potential complications.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the advantages and disadvantages of various corridors to and of pre-operative embolization of lateral ventricular choroid plexus papillomas, 2) Identify the advantages, techniques, and outcomes demonstrated for the superior parietal lobule approach without pre-operative embolization for these tumors.

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