Abstract
Objective
Operative management of choroid plexus tumours is hindered by excessive bleeding and significant CSF production. Our aim was to assess whether the use of preoperative embolisation would increase the safety of surgery by reducing the perioperative blood loss and achieve higher rates of resection of the tumour.
Methods
Between 1996 and 2009, 30 patients (mean age 2.25 years) with choroid plexus tumours (24 papillomas, 6 carcinomas) were treated. Fifteen of them underwent preoperative super-selective embolisation of the feeding vessels with histoacryl glue. The perioperative blood loss as a percentage of estimated blood volume loss (EBV) was recorded together with mortality and morbidity of the two groups (embolised, EMB+ vs. not, EMB−).
Results
The embolisation was successful in 13/15 (86.6 %) patients. This manoeuvre rendered the tumour relatively avascular making the operative field “less hazardous” as reported by the surgeon. In addition, higher gross total resection rate was achieved (100 vs. 41 %; p = 0.001) at the first operative attempt in the EMB+ group. The percentage EBV loss was 96 % in EMB− group vs. 224 % in EMB+ group (p = 0.038).
Conclusion
Our observations with regards to preoperative embolisation of choroid plexus tumours show an acceptable safety profile for the endovascular technique. At the same time, it renders the operative treatment of the tumours safer by reducing perioperative blood loss resulting in a high gross total resection rate. In summary, we suggest that preoperative embolisation is a useful adjunct that should be considered prior to surgical resection in managing these patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lena G, Genitori L, Molina J, Legatte JR, Choux M (1990) Choroid plexus tumours in children. Review of 24 cases. Acta Neurochir (Wien) 106(1–2):68–72
Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, Kalifa C, Brunelle F, Sgouros S et al (1998) Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 88(3):521–528
McEvoy AW, Harding BN, Phipps KP, Ellison DW, Elsmore AJ, Thompson D et al (2000) Management of choroid plexus tumours in children: 20 years experience at a single neurosurgical centre. Pediatr Neurosurg 32(4):192–199
Spallone A, Pastore FS, Giuffre R, Guidetti B (1990) Choroid plexus papillomas in infancy and childhood. Childs Nerv Syst 6(2):71–74
Lafay-Cousin L, Keene D, Carret A-S, Fryer C, Brossard J, Crooks B et al (2010) Choroid plexus tumors in children less than 36 months: the Canadian Pediatric Brain Tumor Consortium (CPBTC) experience. Childs Nerv Syst. http://www.springerlink.com/index/10.1007/s00381-010-1269-9
Wolff JEA, Sajedi M, Brant R, Coppes MJ, Egeler RM (2002) Choroid plexus tumours. Br J Cancer 87(10):1086–1091
McGirr SJ, Ebersold MJ, Scheithauer BW, Quast LM, Shaw EG (1988) Choroid plexus papillomas: long-term follow-up results in a surgically treated series. J Neurosurg 69(6):843–849
Hawkins JC (1980) Treatment of choroid plexus papillomas in children: a brief analysis of twenty years’ experience. Neurosurgery 6(4):380–384
Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58(3):277–280
Faberowski LW, Black S, Mickle JP (1999) Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol 11(3):167–172
Ellenbogen RG, Winston KR, Kupsky WJ (1989) Tumors of the choroid plexus in children. Neurosurgery 25(3):327–335
Berger C, Thiesse P, Lellouch-Tubiana A, Kalifa C, Pierre-Kahn A, Bouffet E (1998) Choroid plexus carcinomas in childhood: clinical features and prognostic factors. Neurosurgery 42(3):470–475
Due-Tonnessen B, Helseth E, Skullerud K, Lundar T (2001) Choroid plexus tumors in children and young adults: report of 16 consecutive cases. Child’s Nervous System 17(4):252–256
Nagib MG, O’Fallon MT (2000) Lateral ventricle choroid plexus papilloma in childhood: management and complications. Surg Neurol 54(5):366–372
Do HM, Marx WF, Khanam H, Jensen ME (2001) Choroid plexus papilloma of the third ventricle: angiography, preoperative embolization, and histology. Neuroradiology 43(6):503–506
Otten ML, Riina HA, Gobin YP, Souweidane MM (2006) Preoperative embolization in the treatment of choroid plexus papilloma in an infant. J Neurosurg Pediatr 104(6):419–421
Takahashi M, Yamamoto J, Aoyama Y, Soejima Y, Akiba D, Nishizawa S (2009) Efficacy of multi-staged surgery and adjuvant chemotherapy for successful treatment of atypical choroid plexus papilloma in an infant: case report. Neurol Med Chir (Tokyo) 49(10):484–487
Strojan P, Popović M, Surlan K, Jereb B (2004) Choroid plexus tumors: a review of 28-year experience. Neoplasma 51(4):306–312
Raimondi AJ, Gutierrez FA (1975) Diagnosis and surgical treatment of choroid plexus papillomas. Childs Brain 1(2–3):81–115
Packer RJ, Perilongo G, Johnson D, Sutton LN, Vezina G, Zimmerman RA et al (1992) Choroid plexus carcinoma of childhood. Cancer 69(2):580–585
Wrede B, Liu P, Wolff JEA (2007) Chemotherapy improves the survival of patients with choroid plexus carcinoma: a meta-analysis of individual cases with choroid plexus tumors. J Neurooncol 85(3):345–351
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Haliasos, N., Brew, S., Robertson, F. et al. Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery?. Childs Nerv Syst 29, 65–70 (2013). https://doi.org/10.1007/s00381-012-1912-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-012-1912-8