Purely neuroendoscopic management of choroid plexus tumors in children.

Abstract

Objective: The goal in this study was to retrospectively evaluate the safety and feasibility of purely neuroendoscopic removal of choroid plexus tumors (CPTs) in children using a monoportal or biportal technique.

Methods: The clinical, radiological, and surgical data of all children with CPTs removed via purely endoscopic or microsurgical approaches in the last 12 years at two centers were retrospectively reviewed. Both centers were fully equipped with advanced neuroendoscopic technology, and surgical teams were fully trained in complex neuroendoscopic intraventricular surgical procedures.

Results: The study involved 32 patients, divided into two groups: 13 undergoing endoscopic procedures and 19 undergoing microsurgical procedures. In the endoscopic group, the mean age was 2.11 years. Eight tumors were located in the lateral ventricles, and 5 in the third ventricle. The mean tumor volume was 6.59 cm3 (range 0.25-15.4 cm3); 9 patients had hydrocephalus at presentation. The monoportal technique was used in 9 patients, and the biportal technique was used in 4 patients. Gross-total removal was achieved in all patients-within a single procedure in 11 patients, and in a two-stage procedure in 2 patients. In the microsurgical group the mean age was 3.75 years. Seventeen tumors were located in the lateral ventricles, and 2 in the third ventricle. The mean tumor volume was 15.07 cm3 (range 1.2-84.35 cm3). The following microsurgical approaches were used: transcortical (n = 11), transcallosal (n = 5), and interhemispheric transprecuneal (n = 3). There was no statistically significant difference between the cases treated via microsurgical and endoscopic approaches with regard to CPT volume (p = 0.06), presence of hydrocephalus (p = 0.22), need for shunt surgery (p = 0.78), or complications (p = 0.06). Furthermore, a statistically significant difference was found in surgery time and blood loss: in endoscopic procedures there was significantly lower blood loss and a shorter surgery time (p < 0.005).

Conclusions: The present study conducted at two hospitals has demonstrated that neuroendoscopic removal of the CPT is a safe and feasible alternative to the conventional microsurgical procedure. The lower blood loss, lower rates of serious complications, and full resolution of hydrocephalus are the main points in favor of neuroendoscopic surgery to obtain gross-total removal of intraventricular CPT in infants and children.