Artikel
Surgical treatment of tumors of the choroid plexus in children
Neurochirurgische Behandlung von Choroidplexustumoren im Kindesalter
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Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Tumors of the choroid plexus are rare, occur in about 2–4%, and are predominantly a tumor in childhood. Retrospectively, we evaluated our young patients, who were operated on plexus tumors during the last ten years. Plexus tumors, especially plexus carcinomas, are known to be highly vascularized and, therefore, pose a major risk during surgery. This study focuses on the surgical procedure and the risks involved.
Methods: Nine patients were included (age range: 3 months to 23 years). Four patients harbored plexus carcinomas (age: 3 months to 3 years), 4 plexus papillomas (age: 14 to 23 years) and 1 chondrosarcoma (age: 13 years). All plexus carcinomas and the chondrosarcoma were located in the temporal and occipital horn of the ventricle; plexus papillomas were also found in the fourth ventricle. The tumors in the cerebrum showed a median diameter of 7 cm. Neurological signs leading to the diagnosis of the tumors were mainly due to the enormous mass effect of tumors, causing symptoms of elevated ICP. None of our patients had signs of a hydrocephalus hypersecretorius.
Results: All tumors were approached through a temporo-occipital craniotomy, or a suboccipital craniectomy; complete tumor resection could be effected in almost all cases. None of the tumors was embolized preoperatively. The blood loss was especially high in cases of plexus carcinomas, which mandated major blood transfusions, caused temporary cerebro-vascular destabilization and difficulties in hemostasis. Since plexus carcinomas were always attributed to neonates and early infants, high blood loss was a serious risk during surgery. There was no mortality and none showed neurological deficits after operation. The dignity of the tumor determined the adjuvant therapy and survival time. One of our patients with plexus carcinoma was repeatedly operated on metastatic spread of the tumor to other parts of the brain.
Conclusions: Tumors of the choroid plexus are highly vascularized. Preoperative embolization of the main tumor feeder may be of advantage. However, the risk of embolization in neonates and infants has to be considered and weighed against the risk of high blood loss and consequent cardiovascular decompensation during surgery.