What Is a Choroid Plexus Papilloma?

Choroid plexus papilloma, also known as epithelioma of choroid plexus or adenoma of choroid plexus, is a benign tumor that grows slowly from the ventricle choroid plexus epithelial cells. Children under the age of 10 are more common, with more men than women, often with hydrocephalus. It is more common in children, especially in the triangular region of the lateral ventricle. Adults are mainly located in the fourth ventricle and CPA (cerebellar pontine angle), and rare in the third ventricle and convex brain. The incidence rate is 0.4% to 0.6% of intracranial tumors, 1.7% to 2.0% of neuroepithelial tumors, and 1.5% to 4% of intracranial tumors in children.

Basic Information

nickname

Choroid plexus epithelioma, choroid plexus adenoma

English name

choroid plexus papilloma

Visiting department

Neurosurgery, Oncology

Multiple groups

Children under 10

Common locations

Ventricle

Common symptoms

Obstructive and / or traffic hydrocephalus, increased intracranial pressure

Causes of choroid plexus papilloma

Slowly growing benign tumors originating from the ventricular choroid plexus epithelial cells.

Clinical manifestations of choroid plexus papilloma

The average course of disease is 1 year, which is mainly manifested by obstructive and / or traffic hydrocephalus (tumor has the function of secreting cerebrospinal fluid, tumor caused cerebrospinal fluid circulation obstruction, tumor bleeding caused by subarachnoid adhesions) and increased intracranial pressure.

1. Hydrocephalus and increased intracranial pressure

In infants, the head is enlarged and the anterior condyle is increased. Older children and adults experience headache, vomiting, papillary edema, paroxysmal coma, and epilepsy.

2. Limited neurological dysfunction

Those who grow in the lateral ventricle often have contralateral mild cone tract signs, those in the third ventricle may have bilateral upper vision difficulties, and those in the fourth ventricle or posterior cranial fossa may have walking instability, nystagmus and ataxia. Dyskinesias can also include head masses, spontaneous subarachnoid hemorrhage, sudden worsening or relief of headaches, and forced head position.

3. Other exceptions

May have stunting, mental symptoms and behavioral abnormalities.

Choroid plexus papilloma

1. Lumbar puncture or ventricle puncture

High pressure, protein content increased significantly, even yellow.

2.X-ray plain film

Signs of increased intracranial pressure (increased indentations in adults and isolated cranial sutures in children) showed calcification in 15% to 20%.

3.CT (Computer Tomography)

Plain scan is the lateral ventricle triangle area or fourth ventricle, equal or high-density mass, clear borders, irregular lobes, may be associated with pathological calcification (about 1/4) and cystic changes, may have ventricular dilatation (located in the skull Posterior fossa is often accompanied by hydrocephalus on the back of the curtain). Papilloma is mostly confined to the ventricle and has no obvious shift of the midline structure; papillary carcinoma is irregular in shape, and is often accompanied by edema and shift of the midline structure.

4.MRI (magnetic resonance imaging)

The lateral ventricle triangle or the fourth ventricle choroid plexus has a clear boundary, a lobular mass with an equal or low T ₁ WI, an equal or slightly higher T ₂ WI signal, and cerebrospinal fluid infiltrating between the nipples to make the tumor "petal-shaped"; visible Vascular pedicle flow signal, ventricular dilatation and significant hydrocephalus; enhanced scan can significantly enhance tumor enhancement.

5. Cerebral angiography

Can show tumor staining, tumor supply arteries and midline structures shift to the healthy side: irregular tumor staining of the lateral ventricular triangle, dilated anterior choroid artery or posterior choroid artery and supply blood to the tumor. The triangle area is the posterior lateral choroid artery, the fourth ventricle is the posterior inferior cerebellar artery, and the third ventricle is the medial posterior choroid artery.

Choroid plexus papilloma diagnosis

The main diagnostic basis is as follows:

1. Children under 10 are more common, with more men than women, often with hydrocephalus. It is more common in children, especially in the lateral ventricle triangle. Adults are mainly located in the fourth ventricle and CPA area.

2. Clinically, the main symptoms are obstructive or traffic hydrocephalus and increased intracranial pressure, which are accompanied by corresponding limited neurological dysfunction according to different tumor sites.

3. The above typical CT and MRI imaging manifestations.

4. The final diagnosis depends on postoperative pathology.

Differential diagnosis of choroid plexus papilloma

1. Occurrence in children is distinguished from ependymal tumors, myeloblasts, and astrocytomas. ,

2. Occurrence in adults is distinguished from meningiomas and metastases.

3. Differential diagnosis from papillary carcinoma is based on postoperative pathology.

Choroid Plexus Papilloma Treatment

1. Choroid plexus papilloma is mostly benign. Surgical resection is the main method to achieve total resection as much as possible; and segmental resection should be avoided to prevent the tumor from spreading along the cerebrospinal fluid. Adhesions to the fourth ventricle should be taken to avoid damage to the brain stem. The main problem during the operation is intraoperative bleeding, which can be performed before the operation of the arterial embolization of the supplying artery, stereotactic intratumor injection of sclerosing agent, preoperative radiation therapy or chemotherapy to reduce the intraoperative bleeding, and the blood supply artery should be blocked before resection of the tumor.

2. If the tumor cannot be completely removed and the hydrocephalus cannot be relieved, shunt surgery should be performed.

3. The most common postoperative complications of choroid plexus papilloma in the apical curtain are the resection of the tumor with the lateral ventricle enlarged and the postoperative collapse of the brain tissue resulting in subdural effusion; if drilling drainage is not effective, dura mater may be used if necessary. Inferior-peritoneal shunt.

4. Radiotherapy should be performed after complete resection, postoperative signs of recurrence, postoperative malignancy, or confirmed as choroid plexus papillary carcinoma (multi-line local radiotherapy).

Prognosis of choroid plexus papilloma

Surgical mortality is controlled below 1%, the 5-year recurrence-free survival rate after total tumor resection is 100%, and the recurrence rate after near-total resection is 0 to 7%.

Those with complete resection can almost be cured; those with no complete resection are not satisfied with the overall prognosis even after chemoradiotherapy. Appearance of cerebrospinal fluid dissemination indicates a poor prognosis, and whole brain and spinal cord MRI examinations and cerebrospinal fluid analysis should be promptly performed.