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Pure endoscopic ultrasonic removal of choroid plexus papillomas of the third ventricle: technical report of two cases

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Abstract

Background

Tumors of the choroid plexus of the third ventricle are uncommon. Surgical excision is technically challenging because of the rich vascularisation, central location, and high incidence in young children. Open microsurgical resection is considered the standard treatment. However, attempts at purely endoscopic removal of choroid plexus tumors of the third ventricle have also been made in the past, with encouraging results.

Case reports

We report our experience with endoscopic ultrasonic removal of two cases of tumors of the third ventricular choroid plexus. The first case was a large atypical choroid plexus papilloma (WHO grade 2) in the anterior third ventricle associated with hydrocephalus; the second case was a smaller choroid plexus papilloma (WHO grade 1) in the middle/posterior third ventricle without overt hydrocephalus requiring a more anterior neuronavigation guided approach.

Discussion and conclusion

Choroid plexus papillomas of the third ventricle can be safely treated by a purely endoscopic approach because they are usually smaller than their counterparts in the lateral ventricle and often have a recognizable vascular pedicle. Early detection and control of the vascular pedicle at the choroidal border is key to success. The use of ultrasonic aspirator facilitates and expedites endoscopic access. By alternating surface coagulation with fragmentation and aspiration with the ultrasonic aspirator, the tumor can be removed without difficult dissection maneuvers.

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Authors and Affiliations

  1. Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Pietro Spennato, Nicola Onorini, Francesca Vitulli, Marianna Di Costanzo, Giuseppe Mirone & Giuseppe Cinalli

  2. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odonotostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Francesca Vitulli & Marianna Di Costanzo

  3. Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy

    Maria Allegra Cinalli

  4. Neurosurgery Department, Ospedale San Gerardo, Monza, Italy

    Maria Allegra Cinalli

Authors
  1. Pietro Spennato
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  2. Nicola Onorini
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  3. Francesca Vitulli
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  4. Maria Allegra Cinalli
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  5. Marianna Di Costanzo
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  6. Giuseppe Mirone
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  7. Giuseppe Cinalli
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Contributions

Primary surgeon video 1: Mirone. Primary surgeon video 2: Spennato. Assistant surgeon/supervisor: Cinalli G. Editing and drafting the video and manuscript: Spennato, Onorini, Vitulli, Cinalli M. A., Mirone. Critically revising the work: Cinalli G., Spennato. Approved the final version of the work on behalf of all authors: Spennato. Supervision: Cinalli G. All authors reviewed the manuscript.

Corresponding author

Correspondence to Pietro Spennato.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in the studies involving human participants conformed to the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. Written informed consent was obtained from the parents for publication of the details of the medical case and associated images. Because this was a retrospective case report and all procedures performed were part of routine care, the study was exempt from ethical approval by the institutional review board.

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The authors declare no competing interests.

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Spennato, P., Onorini, N., Vitulli, F. et al. Pure endoscopic ultrasonic removal of choroid plexus papillomas of the third ventricle: technical report of two cases. Childs Nerv Syst 39, 3415–3420 (2023). https://doi.org/10.1007/s00381-023-05979-0

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