title: Preoperative embolisation of choroid plexus tumours in children: part I-does the reduction of perioperative blood loss affect the safety of subsequent surgery?
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK. nhaliasos@gmail.com
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Haliasos
authors.forename: Stefan
authors.initials: S
authors.lastname: Brew
authors.forename: Fergus
authors.initials: F
authors.lastname: Robertson
authors.forename: Richard
authors.initials: R
authors.lastname: Hayward
authors.forename: Dominic
authors.initials: D
authors.lastname: Thompson
authors.forename: Aabir
authors.initials: A
authors.lastname: Chakraborty
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001811:Blood Volume Determination; D002648:Child; D002675:Child, Preschool; D016545:Choroid Plexus Neoplasms / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009493:Neurosurgery / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004659:Enbucrilate