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Tumor Discovery Choroid plexus tumors: Benign to malignant

system. This minimally invasive nature of the treatment complications, neuroendoscopy may be the preferred
and the inherent association CPTs have with the ventricular method to minimize surgical trauma in this fragile
system make it an appealing technology for CPT resection. population. The minimal surgical trauma associated with
Limitations of this approach include large tumor size, neuroendoscopy was the primary reason for adopting a
dense vascularization, and inability to tolerate long surgical monoportal neuroendoscopic approach in a 5-month-old
procedures . Therefore, the indications for this type of male infant and a 10-week-old male infant, who might not
[89]
surgery include small tumor size (<3 cm in diameter), lack have survived the trauma of open surgery [92,93] .
of hard consistency, and poor vascularization . As CPTs While these case reports focus on tumors that meet the
[90]
of the third ventricle tend to be smaller and less vascular
than their counterparts in the lateral ventricle, most cases size criteria for endoscopic resection, endoscopy can also
of pure endoscopic resection focused on tumors in this be used for large tumors in a segmental removal approach,
site, with some more recent exceptions . allowing smaller segments to pass through the scope port.
[91]
Optical and electromagnetic neuronavigation may obviate
While neuroendoscopy has gained growing popularity the need for ventricular dilatation, which in the past was
in the context of choroid plexus coagulation, open considered a prerequisite for ventricular neuroendoscopy.
microsurgical resection is still considered the standard The use of modern neuroendoscopic tools, such as
treatment of CPT resection. Nevertheless, several purely endoscopic ultrasonic surgical aspirators, may obviate
endoscopic resections of CPTs have been attempted in the some of these limitations in the future [90,100] .
past, yielding promising results [92-99] . Some approaches,
such as those reported by Reddy et al., involved a hybrid 4.2. LITT and PTT
endoscopic and microsurgical approach to a third ventricle LITT is a less invasive approach that uses laser energy to
CPT . In this case, endoscopy was used initially to biopsy heat and destroy tumor cells. LITT is usually MRI-guided
[94]
and mobilizes the tumor from the third ventricle into the and particularly useful for tumors in difficult-to-reach
lateral ventricle, followed by open removal of resected areas, such as CPTs. Despite this, therapeutic application
tissue via a transcortical approach.
in growths of the choroid plexus has been very limited.
Spennato et al. recently reported two cases of pure While LITT has historically been indicated for recurrent
endoscopic removal of CPPs in the 3 ventricle: one glioblastoma, it has continued to see success in treating
rd
in a 7-month-old infant with macrocrania and bulging other brain tumors [101-105] . A case series by Tovar-Spinoza
fontanel, and another in a 3-year-old boy who underwent and Choi followed 11 pediatric patients with 12 brain
an MRI because of a month-long headache. In both cases, tumors and reported successful ablations with minimal
tumors were successfully resected, and MRI confirmed the complications using LITT [106] . Although many of the lesions
absence of recurrence at the 3-year and 5-year follow-up, treated were located in difficult and risky areas to treat,
respectively. As these tumors have a higher incidence in such as the cerebellar peduncle, thalamus, or midbrain,
infants and toddlers, who are more susceptible to surgical only a single patient with 2 choroid plexus growths was
treated. Based on these findings, while administration of
LITT in the choroid plexus is possible, further pre-clinical
trials using animal models are warranted to optimize the
treatment of cancerous growths in this region.
PTT is another novel, non-invasive cancer treatment
which has emerged in recent years [107,108] . This therapy
uses photothermal agents that absorb light energy and
convert it into thermal energy to induce heat ablation
of tumor cells upon laser irradiation [109] . There are two
general methods: traditional PTT (>50°C) and mild PTT
(42 – 45°C). Traditional PTT uses high heat to induce
tumor necrosis but may result in inevitable damage and
inflammation of surrounding tissue [110] . In contrast, mild
PTT is a more promising technology for brain tumors
because of its negligible side effects, inducing apoptosis
rather than necrosis [111] . Furthermore, mild PTT offers
Figure 1. Axial non-contrast computed tomography of a choroid plexus
®
carcinoma. Source: MedPix (Smirniotopoulos JG, 2009), https://medpix. the added advantages of loosening the dense structure in
nlm.nih.gov/case?id=2ae2b1c4-9029-4535-8f1b-a12a8c9e3a8f. tumor tissues, enhancing blood perfusion, and alleviating

Volume 2 Issue 2 (2023) 5 https://doi.org/10.36922/td.1057