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.