Choroid plexus papilloma of the cerebellopontine angle: A twelve patient series

BACKGROUND Choroid plexus papillomas (CPPs), of the cerebellopontine angle (CPA), are a rare entity and no surgical series have been reported so far. We reviewed all the pertinent literature of 12 patients operated on in the last 20 yea rs at our institution. METHODS All the patients were adults, ranging from 19 to 61 years. The group includ ed 6 males and 6 females. Preoperatively, on computerized tomography (CT) ( n = 10) or magnetic resonance imaging (MRI) (n = 4), differential diagnosis was difficult to achieve, especially with meningiomas. Hydrocephalus was d isclosed in 8 cases. Angiography (n = 11) showed tumor blush with typical v ascular supply in almost half the cases. RESULTS In 6 patients a midline approach via the cerebellomedullary fissure was use d; in the remaining 6 patients the retromastoid route was adopted. We found 2 "unconnected" tumors; no hilum was identified at surgery. Total tumor re moval was achieved in 6 patients, predominantly in the last cases. Two pati ents died in the postoperative period, 3 patients had mild additional defic its, whereas 7 patients were stable or improved. All the patients were foll owed up for a mean period of 8.2 years. Conventional radiotherapy was carri ed out in 5 patients; 1 of them after tumor recurrence. Stereotactic radiot herapy was performed in 3 patients; 2 of them after recurrences. Two patien ts showed tumor progression and died during the follow-up. One of them pres ented a suprasellar metastasis and died much earlier (2 versus 7 years). CONCLUSION Careful assessment and surgical planning is accomplished with the combined information from CT, MRI, and angiography. Typical characteristics are the following: vascular supply from the choroidal arteries, ventral extension, adhesion to the brainstem, and lower cranial nerves. Nowadays, total remova l of CPPs of the CPA can be achieved with acceptable morbidity and mortalit y. In our experience, conventional radiotherapy did not prove effective. (C ) 1999 by Elsevier Science Inc.