Top

Published in:

Open Access 01-04-2019 | Original Article - Brain Tumors

Management of choroid plexus tumors—an institutional experience

Authors: Arthur Hosmann, Felix Hinker, Christian Dorfer, Irene Slavc, Christine Haberler, Karin Dieckmann, Engelbert Knosp, Thomas Czech

Published in: Acta Neurochirurgica | Issue 4/2019

Abstract

Background

Choroid plexus tumors are rare entities. Resection is the mainstay of treatment in grade I and grade II tumors and adjuvant treatment is usually reserved for the less frequent choroid plexus carcinoma (CPC). Outcome is not only related to their histological grade but also dependent on their size, location, and presence of often multifactorial disturbances of cerebrospinal fluid (CSF) circulation.

Methods

Retrospective analysis of 36 consecutive patients operated on a choroid plexus tumor at our institution in a mixed pediatric and adult population between 1991 and 2016.

Results

Twenty-one CPP, 11 atypical choroid plexus papillomas (aCPP), and four CPC were encountered in 17 children and 19 adults. Regardless of histological grading, gross-total resection (GTR) could be achieved in 91.7% of patients. Tumor recurrence (25.0%) was significantly associated with histological grading (p = 0.004), subtotal resection (p = 0.002), and intraoperatively evident zones of tumor infiltration (p = 0.001). Adjuvant therapy was performed in 19.4% of patients, mainly diagnosed with CPC. The 5-year overall survival rate was 95.2% for CPP and 100.0% for both aCPP and CPC. Survival was related to the extent of resection (p = 0.001), tumor progression (p = 0.04), and the presence of leptomeningeal metastases (p = 0.002). Even after resection, either ventricular or subdural shunting was required in 25.0% of patients.

Conclusions

We could confirm that GTR is crucial for treatment of choroid plexus tumors. Parenchymal tumor infiltration as detected intraoperatively was associated with the extent of resection and not limited to CPC. CSF disturbances mandating treatment may persist after resection.

Abdulkader MM, Mansour NH, Van Gompel JJ, Bosh GA, Dropcho EJ, Bonnin JM, Cohen-Gadol AA (2016) Disseminated choroid plexus papillomas in adults: a case series and review of the literature. J Clin Neurosci 32:148–154. https://doi.org/10.1016/j.jocn.2016.04.002 CrossRefPubMed

Bahar M, Hashem H, Tekautz T, Worley S, Tang A, de Blank P, Wolff J (2017) Choroid plexus tumors in adult and pediatric populations: the Cleveland Clinic and University Hospitals experience. J Neuro-Oncol 132:427–432. https://doi.org/10.1007/s11060-017-2384-1 CrossRef

Bahar M, Kordes U, Tekautz T, Wolff J (2015) Radiation therapy for choroid plexus carcinoma patients with Li-Fraumeni syndrome: advantageous or detrimental? Anticancer Res 35:3013–3017PubMed

Bavinzski G, Killer M, Gruber A, Reinprecht A, Gross CE, Richling B (1999) Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience. J Neurosurg 90:843–852. https://doi.org/10.3171/jns.1999.90.5.0843 CrossRefPubMed

Berger C, Thiesse P, Lellouch-Tubiana A, Kalifa C, Pierre-Kahn A, Bouffet E (1998) Choroid plexus carcinomas in childhood: clinical features and prognostic factors. Neurosurgery 42:470–475CrossRefPubMed

Bering EA (1962) Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement. J Neurosurg 19:405–413. https://doi.org/10.3171/jns.1962.19.5.0405 CrossRefPubMed

Bettegowda C, Adogwa O, Mehta V, Chaichana KL, Weingart J, Carson BS, Jallo GI, Ahn ES (2012) Treatment of choroid plexus tumors: a 20-year single institutional experience. J Neurosurg Pediatr 10:398–405. https://doi.org/10.3171/2012.8.PEDS12132 CrossRefPubMedPubMedCentral

Boyd MC, Steinbok P (1987) Choroid plexus tumors: problems in diagnosis and management. J Neurosurg 66:800–805. https://doi.org/10.3171/jns.1987.66.6.0800 CrossRefPubMed

Cannon DM, Mohindra P, Gondi V, Kruser TJ, Kozak KR (2015) Choroid plexus tumor epidemiology and outcomes: implications for surgical and radiotherapeutic management. J Neuro-Oncol 121:151–157. https://doi.org/10.1007/s11060-014-1616-x CrossRef

10.

Chow E, Jenkins JJ, Burger PC, Reardon DA, Langston JW, Sanford RA, Heideman RL, Kun LE, Merchant TE (1999) Malignant evolution of choroid plexus papilloma. Pediatr Neurosurg 31:127–130CrossRefPubMed

11.

Di Rocco C, Pettorossi VE, Caldarelli M, Mancinelli R, Velardi F (1977) Experimental hydrocephalus following mechanical increment of intraventricular pulse pressure. Experientia 33:1470–1472CrossRefPubMed

12.

Dorfer C, Czech T, Bavinzski G, Kitz K, Mert A, Knosp E, Gruber A (2010) Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience. Childs Nerv Syst 26:681–687. https://doi.org/10.1007/s00381-009-1039-8 CrossRefPubMed

13.

Due-Tønnessen B, Helseth E, Skullerud K, Lundar T (2001) Choroid plexus tumors in children and young adults: report of 16 consecutive cases. Childs Nerv Syst 17:252–256CrossRefPubMed

14.

El-Deiry WS (2003) The role of p53 in chemosensitivity and radiosensitivity. Oncogene 22:7486–7495. https://doi.org/10.1038/sj.onc.1206949 CrossRefPubMed

15.

Ellenbogen RG, Winston KR, Kupsky WJ (1989) Tumors of the choroid plexus in children. Neurosurgery 25:327–335CrossRefPubMed

16.

Fitzpatrick LK, Aronson LJ, Cohen KJ (2002) Is there a requirement for adjuvant therapy for choroid plexus carcinoma that has been completely resected? J Neuro-Oncol 57:123–126CrossRef

17.

Gupta N (2003) Choroid plexus tumors in children. Neurosurg Clin N Am 14:621–631CrossRefPubMed

18.

Haliasos N, Brew S, Robertson F, Hayward R, Thompson D, Chakraborty A (2013) Preoperative embolisation of choroid plexus tumours in children: part I-does the reduction of perioperative blood loss affect the safety of subsequent surgery? Childs Nerv Syst 29:65–70. https://doi.org/10.1007/s00381-012-1912-8 CrossRefPubMed

19.

Hosmann A, El-Garci A, Gatterbauer B, Bavinzski G, Knosp E, Gruber A (2018) Multimodality management of vein of Galen malformations-an institutional experience. World Neurosurg 112:e837–e847. https://doi.org/10.1016/j.wneu.2018.01.172 CrossRefPubMed

20.

Jeibmann A, Hasselblatt M, Gerss J, Wrede B, Egensperger R, Beschorner R, Hans VH, Rickert CH, Wolff JE, Paulus W (2006) Prognostic implications of atypical histologic features in choroid plexus papilloma. J Neuropathol Exp Neurol 65:1069–1073. https://doi.org/10.1097/01.jnen.0000240464.26005.90 CrossRefPubMed

21.

Jeibmann A, Wrede B, Peters O, Wolff JE, Paulus W, Hasselblatt M (2007) Malignant progression in choroid plexus papillomas. J Neurosurg 107:199–202. https://doi.org/10.3171/PED-07/09/199 CrossRefPubMed

22.

Koh EJ, Wang KC, Phi JH, Lee JY, Choi JW, Park SH, Park KD, Kim IH, Cho BK, Kim SK (2014) Clinical outcome of pediatric choroid plexus tumors: retrospective analysis from a single institute. Childs Nerv Syst 30:217–225. https://doi.org/10.1007/s00381-013-2223-4 CrossRefPubMed

23.

Krishnan S, Brown PD, Scheithauer BW, Ebersold MJ, Hammack JE, Buckner JC (2004) Choroid plexus papillomas: a single institutional experience. J Neuro-Oncol 68:49–55CrossRef

24.

Kumar R, Singh S (2005) Childhood choroid plexus papillomas: operative complications. Childs Nerv Syst 21:138–143. https://doi.org/10.1007/s00381-004-0993-4 CrossRefPubMed

25.

Lena G, Genitori L, Molina J, Legatte JR, Choux M (1990) Choroid plexus tumours in children. Review of 24 cases. Acta Neurochir 106:68–72CrossRefPubMed

26.

Levy ML, Goldfarb A, Hyder DJ, Gonzales-Gomez I, Nelson M, Gilles FH, McComb JG (2001) Choroid plexus tumors in children: significance of stromal invasion. Neurosurgery 48:303–309PubMed

27.

Mallick S, Benson R, Melgandi W, Rath GK (2017) Effect of surgery, adjuvant therapy, and other prognostic factors on choroid plexus carcinoma: a systematic review and individual patient data analysis. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2017.08.012

28.

Maria BL, Graham ML, Strauss LC, Wharam MD (1985) Response of a recurrent choroid plexus tumor to combination chemotherapy. J Neuro-Oncol 3:259–262CrossRef

29.

Mazloom A, Wolff JE, Paulino AC (2010) The impact of radiotherapy fields in the treatment of patients with choroid plexus carcinoma. Int J Radiat Oncol Biol Phys 78:79–84. https://doi.org/10.1016/j.ijrobp.2009.07.1701 CrossRefPubMed

30.

McEvoy AW, Harding BN, Phipps KP, Ellison DW, Elsmore AJ, Thompson D, Harkness W, Hayward RD (2000) Management of choroid plexus tumours in children: 20 years experience at a single neurosurgical centre. Pediatr Neurosurg 32:192–199CrossRefPubMed

31.

Merino DM, Shlien A, Villani A, Pienkowska M, Mack S, Ramaswamy V, Shih D, Tatevossian R, Novokmet A, Choufani S, Dvir R, Ben-Arush M, Harris BT, Hwang EI, Lulla R, Pfister SM, Achatz MI, Jabado N, Finlay JL, Weksberg R, Bouffet E, Hawkins C, Taylor MD, Tabori U, Ellison DW, Gilbertson RJ, Malkin D (2015) Molecular characterization of choroid plexus tumors reveals novel clinically relevant subgroups. Clin Cancer Res 21:184–192. https://doi.org/10.1158/1078-0432.CCR-14-1324 CrossRefPubMed

32.

Morshed RA, Lau D, Sun PP, Ostling LR (2017) Spinal drop metastasis from a benign fourth ventricular choroid plexus papilloma in a pediatric patient: case report. J Neurosurg Pediatr:1–9. https://doi.org/10.3171/2017.5.PEDS17130

33.

Nimjee SM, Powers CJ, McLendon RE, Grant GA, Fuchs HE (2010) Single-stage bilateral choroid plexectomy for choroid plexus papilloma in a patient presenting with high cerebrospinal fluid output. J Neurosurg Pediatr 5:342–345. https://doi.org/10.3171/2009.10.PEDS08454 CrossRefPubMed

34.

Packer RJ, Perilongo G, Johnson D, Sutton LN, Vezina G, Zimmerman RA, Ryan J, Reaman G, Schut L (1992) Choroid plexus carcinoma of childhood. Cancer 69:580–585CrossRefPubMed

35.

Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, Kalifa C, Brunelle F, Sgouros S, Meyer P, Cinalli G, Zerah M, Pierre-Kahn A, Renier D (1998) Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 88:521–528. https://doi.org/10.3171/jns.1998.88.3.0521 CrossRefPubMed

36.

Ruland V, Hartung S, Kordes U, Wolff JE, Paulus W, Hasselblatt M (2014) Choroid plexus carcinomas are characterized by complex chromosomal alterations related to patient age and prognosis. Genes Chromosomes Cancer 53:373–380. https://doi.org/10.1002/gcc.22148 CrossRefPubMed

37.

Rytting ME (2017) CPT-SIOP-2009: Intercontinental multidisciplinary registry and treatment optimization study for patients with choroid plexus tumors. https://clinicaltrials.gov/ct2/show/NCT00500890. Accessed 3 sept 2018

38.

Schneider C, Kamaly-Asl I, Ramaswamy V, Lafay-Cousin L, Kulkarni AV, Rutka JT, Remke M, Coluccia D, Tabori U, Hawkins C, Bouffet E, Taylor MD (2015) Neoadjuvant chemotherapy reduces blood loss during the resection of pediatric choroid plexus carcinomas. J Neurosurg Pediatr 16:126–133. https://doi.org/10.3171/2014.12.PEDS14372 CrossRefPubMed

39.

Siegfried A, Morin S, Munzer C, Delisle MB, Gambart M, Puget S, Maurage CA, Miquel C, Dufour C, Leblond P, André N, Branger DF, Kanold J, Kemeny JL, Icher C, Vital A, Coste EU, Bertozzi AI (2017) A French retrospective study on clinical outcome in 102 choroid plexus tumors in children. J Neuro-Oncol 135:151–160. https://doi.org/10.1007/s11060-017-2561-2 CrossRef

40.

Sun MZ, Ivan ME, Oh MC, Delance AR, Clark AJ, Safaee M, Oh T, Kaur G, Molinaro A, Gupta N, Parsa AT (2014) Effects of adjuvant chemotherapy and radiation on overall survival in children with choroid plexus carcinoma. J Neuro-Oncol 120:353–360. https://doi.org/10.1007/s11060-014-1559-2 CrossRef

41.

Tabori U, Shlien A, Baskin B, Levitt S, Ray P, Alon N, Hawkins C, Bouffet E, Pienkowska M, Lafay-Cousin L, Gozali A, Zhukova N, Shane L, Gonzalez I, Finlay J, Malkin D (2010) TP53 alterations determine clinical subgroups and survival of patients with choroid plexus tumors. J Clin Oncol 28:1995–2001. https://doi.org/10.1200/JCO.2009.26.8169 CrossRefPubMed

42.

Tacconi L, Delfini R, Cantore G (1996) Choroid plexus papillomas: consideration of a surgical series of 33 cases. Acta Neurochir 138:802–810CrossRefPubMed

43.

Thomas C, Ruland V, Kordes U, Hartung S, Capper D, Pietsch T, Gerß J, Wolff JE, Paulus W, Hasselblatt M (2015) Pediatric atypical choroid plexus papilloma reconsidered: increased mitotic activity is prognostic only in older children. Acta Neuropathol 129:925–927. https://doi.org/10.1007/s00401-015-1434-z CrossRefPubMed

44.

Thomas C, Sill M, Ruland V, Witten A, Hartung S, Kordes U, Jeibmann A, Beschorner R, Keyvani K, Bergmann M, Mittelbronn M, Pietsch T, Felsberg J, Monoranu CM, Varlet P, Hauser P, Olar A, Grundy RG, Wolff JE, Korshunov A, Jones DT, Bewerunge-Hudler M, Hovestadt V, von Deimling A, Pfister SM, Paulus W, Capper D, Hasselblatt M (2016) Methylation profiling of choroid plexus tumors reveals 3 clinically distinct subgroups. Neuro-Oncology 18:790–796. https://doi.org/10.1093/neuonc/nov322 CrossRefPubMedPubMedCentral

45.

Valencak J, Dietrich W, Raderer M, Dieckmann K, Prayer D, Hainfellner JA, Marosi C (2000) Evidence of therapeutic efficacy of CCNU in recurrent choroid plexus papilloma. J Neuro-Oncol 49:263–268CrossRef

46.

Wind JJ, Bell RS, Bank WO, Myseros JS (2010) Treatment of third ventricular choroid plexus papilloma in an infant with embolization alone. J Neurosurg Pediatr 6:579–582. https://doi.org/10.3171/2010.9.PEDS1039 CrossRefPubMed

47.

Wolff JE, Sajedi M, Brant R, Coppes MJ, Egeler RM (2002) Choroid plexus tumours. Br J Cancer 87:1086–1091. https://doi.org/10.1038/sj.bjc.6600609 CrossRefPubMedPubMedCentral

48.

Wolfsberger S, Gruber A, Czech T (2004) Multiple supratentorial epidural haematomas after posterior fossa surgery. Neurosurg Rev 27:128–132. https://doi.org/10.1007/s10143-003-0315-4 CrossRefPubMed

49.

Wrede B, Hasselblatt M, Peters O, Thall PF, Kutluk T, Moghrabi A, Mahajan A, Rutkowski S, Diez B, Wang X, Pietsch T, Kortmann RD, Paulus W, Jeibmann A, Wolff JE (2009) Atypical choroid plexus papilloma: clinical experience in the CPT-SIOP-2000 study. J Neuro-Oncol 95:383–392. https://doi.org/10.1007/s11060-009-9936-y CrossRef

50.

Zaky W, Dhall G, Khatua S, Brown RJ, Ginn KF, Gardner SL, Yildiz VO, Yankelevich M, Finlay JL (2015) Choroid plexus carcinoma in children: the Head Start experience. Pediatr Blood Cancer 62:784–789. https://doi.org/10.1002/pbc.25436 CrossRefPubMed

Title: Management of choroid plexus tumors—an institutional experience
Authors: Arthur Hosmann
Felix Hinker
Christian Dorfer
Irene Slavc
Christine Haberler
Karin Dieckmann
Engelbert Knosp
Thomas Czech
Publication date: 01-04-2019
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 4/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-03832-5

ACC 2024 Congress

Springer Medicine

Management of choroid plexus tumors—an institutional experience

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2019

Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors

Lausanne checklist for safe stereotactic radiosurgery

Fluorescence-guided neurosurgery—neuro-oncology and cerebrovascular applications (2019) by Constantinos G. Hadjipanayis and Walter Stummer (eds.)

Correction to: Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry

Factors related to improvement of cerebrovascular reserve after superficial temporal artery to middle cerebral artery anastomosis for patients with atherosclerotic steno-occlusive disease

Bridging vein and tentorial sinus in the subtemporal corridor during the anterior transpetrosal approach