Preoperative Devascularization of Choroid Plexus Tumors: Specific Issues about Anatomy and Embolization Technique

Abstract

(1) Background: Surgical treatment of choroid plexus tumors is challenging, burdened by a notable risk of bleeding. Neoadjuvant chemotherapy and preoperative embolization have been attempted, with encouraging results; however, the consensus on these procedures is lacking. (2) Methods: We present a case of a 10-month-old girl who underwent preoperative embolization of a hemorrhagic choroid plexus carcinoma of the lateral ventricle via the anterior choroidal artery, followed by total resection. (3) Results: The endovascular procedure was successfully completed, despite the rectification of the anterior choroidal artery associated with the absence of flow proximal to the plexal point. Minimal bleeding was observed during resection and the patient remained neurologically intact. (4) Conclusions: The time from entrance to exit in the anterior choroidal artery should be monitored and regarded as a potential ‘occlusion time’ in this specific group of patients. Nevertheless, our case supports the feasibility and effectiveness of preoperative embolization of a choroid plexus carcinoma of the lateral ventricle via the anterior choroidal artery, without complications. Furthermore, we suggest the use of a fast-embolic agent, such as N-butyl cyanoacrylate glue, as the preferred agent for this specific pathology and patient population.

Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors

“…Choice of embolic should take into consideration the effect of catheterization on the parent vessel and risk of non-target embolization. Baro et al [36] describe a case of PPE with nBCA where the parent artery is not seen on control angiography but reappeared on delayed angiography suggestive of spasm. This is an example of the need to minimize catheter dwell time as well as the benefit of fast polymerizing embolic agents.…”

“…Embolic agents for CPT include n-butyl cyanoacrylate (nBCA) [22, 36], histoacryl [32], onyx [37], and polyvinyl alcohol (PVA) [22, 38]. Choice of embolic should take into consideration the effect of catheterization on the parent vessel and risk of non-target embolization.…”

X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study

“…A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available in clinical practice. The spectrum of highly prevalent health conditions for which liquid embolic agents including N-butyl cyanoacrylate (NBCA) have been proven useful is expanding steadily and now includes lower urinary-tract symptoms due to prostate enlargement, aneurysms and pseudoaneurysms, arteriovenous malformations, other vascular lesions responsible for bleeding, and solid tumors [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. NBCA glues have been extensively studied since the late 1980s.…”

Durability of an endoscopic management strategy for recurrent choroid plexus carcinoma with a comprehensive molecular characterization: illustrative case

“…6 In response to this, therapeutic schemes to facilitate safe and effective second-look surgery (i.e., neoadjuvant chemotherapy or arterial embolization) are advocated. 5,7,8 Recurrence of CPC is common, but there are sparse reports of long-term outcomes for patients who have had recurrence, particularly in nonsyndromic cases. 9,10 Likewise, there is limited knowledge regarding molecular drivers of tumor recurrence.…”

“… 6 In response to this, therapeutic schemes to facilitate safe and effective second-look surgery (i.e., neoadjuvant chemotherapy or arterial embolization) are advocated. 5 , 7 , 8 …”