title: Embolization of a giant hypervascularized choroid plexus papilloma with onyx by direct puncture: a case report.
abstract: BACKGROUND
  Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization.
  
  
  METHODS
  We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed.
  
  
  RESULTS
  Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits.
  
  
  CONCLUSIONS
  Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.
authors.affiliation: Neurosurgery Department, Residence Program, Neurological Institute of Curitiba (INC), Rua Jeremias Maciel Perretto, 300, 81210-310, Curitiba, Paraná, Brazil. gustavosjung@gmail.com.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Jung
authors.affiliation: Neurosurgery Department, Residence Program, Neurological Institute of Curitiba (INC), Rua Jeremias Maciel Perretto, 300, 81210-310, Curitiba, Paraná, Brazil.
authors.forename: Leonardo G
authors.initials: LG
authors.lastname: Ruschel
authors.affiliation: Neurosurgery Department, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil.
authors.forename: Andre G
authors.initials: AG
authors.lastname: Leal
authors.affiliation: Neurosurgery Department, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramina
mesh_terms: D015901:Angiography, Digital Subtraction; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D020288:Papilloma, Choroid Plexus / Q000000981:diagnostic imaging / Q000601:surgery*; D011145:Polyvinyls / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D019786:Gadolinium DTPA; D004121:Dimethyl Sulfoxide
keywords: Brain neoplasm; Choroid plexus tumor; Therapeutic embolizations