Optimized surgical approach to third ventricular choroid plexus papillomas of young children based on anatomical variations

Abstract

Background: Choroid plexus papilloma (CPP) in the third ventricle is a rare benign intracranial tumor.

Methods: We report 3 pediatric cases of CPP in the third ventricle. The lesions were totally removed by a different surgical approach in each case.

Results: When remarkable hydrocephalus is present, the transcortical approach is easier to perform, but may expose the patient to epilepsy and subdural effusion postoperatively. The transcallosal approach offers direct exposure of the ventricle system with minimal risk of cortical damage. The transcallosal-transforaminal approach with posterior enlargement of the foramen of Monro along the choroidal fissure provides a direct trajectory into the third ventricle through the natural cleft. The transcallosal-interforniceal approach does not depend on the size of the foramen of Monro, but it carries a risk for damage to the both fornices. The midline plane of the septum pellucidum and the forniceal columns in children are sometimes easily identifiable and separable, and in such cases the transcallosal-interforniceal approach appears to be a safe route for tumors extending to the posterior third ventricle. The interforniceal approach should be reserved for lesions that cannot be removed safely via the transforaminal approach.

Conclusions: Young children have a small total blood volume and fragile cardiovascular status. Therefore, it is critical to preserve the venous system and to ligate the feeding artery before extirpation of the tumor. The surgical approach to the third ventricular CPPs should be tailored to individual children based on tumor size, location, and vascularity.

Keywords: Third ventricle choroid plexus papilloma; Transcallosal approach; Transcortical approach.