Excision of Large Pediatric Supratentorial Choroid Plexus Tumors by Endoscope-Assisted Microsurgery

Abstract Background: Intraventricular tumors (IVTs) are commoner in children than in adults. They represent a technical challenge during microsurgery in children due to their large size, deep location, and propensity for bleeding. Aim of Study: We study the value of using endoscope-assistance in surgery of large choroid plexus tumors (CPTs) in children. Patients and Methods: Pediatric patients with large CPTs were studied retrospectively from 2015-2019. Transcortical microsurgery was performed using various approaches. The endoscope was used to inspect the tumor and its pedicle. After excision, it was reintroduced to search for any missed parts and to aid in hemostasis. Results: The study included 11 patients. Eight patients (72.73%) presented with manifestations of increased intrac-ranial pressure. Three patients (27.27%) presented with hemi-paresis. Only 2 patients needed permanent CSF diversion. Blood transfusion was required in some patients: 300cc in 6 patients, 200cc in 4 patients, and 150cc in 2 patients. The pathology results were papilloma in 6 patients, atypical papilloma in 1 patient, and carcinoma in 4 patients. Gross total resection was achieved in 9 cases. Subtotal resection was found in 2 cases. Follow-up MRI after 3 months, 2 and 4 years showed a stationary course. Transient hemiparesis was present in 2 cases and improved with physiotherapy. We did not witness mortality. Conclusion: Endoscope-assisted microsurgery permits safe and efficient excision of large CPTs in children. It aids in complete excision which may improve survival and may avoid permanent CSF diversion.