Published in:
01-01-2013 | Original Paper
Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery?
Published in: Child's Nervous System | Issue 1/2013
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Objective
Operative management of choroid plexus tumours is hindered by excessive bleeding and significant CSF production. Our aim was to assess whether the use of preoperative embolisation would increase the safety of surgery by reducing the perioperative blood loss and achieve higher rates of resection of the tumour.
Methods
Between 1996 and 2009, 30 patients (mean age 2.25 years) with choroid plexus tumours (24 papillomas, 6 carcinomas) were treated. Fifteen of them underwent preoperative super-selective embolisation of the feeding vessels with histoacryl glue. The perioperative blood loss as a percentage of estimated blood volume loss (EBV) was recorded together with mortality and morbidity of the two groups (embolised, EMB+ vs. not, EMB−).
Results
The embolisation was successful in 13/15 (86.6 %) patients. This manoeuvre rendered the tumour relatively avascular making the operative field “less hazardous” as reported by the surgeon. In addition, higher gross total resection rate was achieved (100 vs. 41 %; p = 0.001) at the first operative attempt in the EMB+ group. The percentage EBV loss was 96 % in EMB− group vs. 224 % in EMB+ group (p = 0.038).
Conclusion
Our observations with regards to preoperative embolisation of choroid plexus tumours show an acceptable safety profile for the endovascular technique. At the same time, it renders the operative treatment of the tumours safer by reducing perioperative blood loss resulting in a high gross total resection rate. In summary, we suggest that preoperative embolisation is a useful adjunct that should be considered prior to surgical resection in managing these patients.