Abstract
Background:
Choroid plexus papilloma (CPP) is a rare tumor of the central nervous system. The most common CPP surgery complication is intraoperative bleeding, mainly in cases of posterior inferior cerebellar artery (PICA) branch encasement. In these cases, early identification of the PICA and tumor feeding vessels is necessary, with their proximal control, and progressive coagulation of the choroid plexus, aiming to reduce the blood supply to the tumor. This video explains step-by-step the surgical technique CPP with intraoperative PICA breach bleeding.
Case Description:
We present a 48-year-old female with a year of progressive occipital headache and 2 weeks of ataxia and dizziness. In neurological examination, she presented with gait ataxia. The imaging investigation with magnetic resonance showed a fourth ventricle mass of 2,8 centimeter, with cerebellar compression and left PICA encasement. The treatment was a surgical resection by a suboccipital approach. There was a rupture of a PICA branch during tumor resection, which was controlled with compression and bipolar coagulation. A near-total resection was performed with a small tumor remnant remaining in the PICA. The patient evolved with improvement of pre-operative symptoms. Tumor biopsy confirms the CPP diagnosis.
Conclusion:
CPP of the fourth ventricle is a rare benign tumor, which should be included in the differential diagnosis of intraventricular tumors. The IV ventricle location presents additional surgical challenges, such as arterial encasement and brainstem adhesions. This surgical video highlights the main techniques to perform an IV ventricle CPP resection.
Keywords: Brainstem, Choroid plexus papilloma, Posterior fossa tumor, Suboccipital approach
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Annotations[1-7]
00:09 - case presentation
00:26 - Neuro-imaging Findings
03:28 - Surgical key steps
6:52 - Disease Background
7:43 - Clinical outcome
Footnotes
How to cite this article: Caramanti R, Aprígio RM, Rocha C, Gonsalves DG, de Morais DF, de Aguiar P, et al. Suboccipital approach for fourth ventricle choroid plexus papilloma: 3-dimensional operative video. Surg Neurol Int. 2025;16:341. doi: 10.25259/SNI_312_2025
Contributor Information
Ricardo Lourenço Caramanti, Email: ricardocaramanti1987@gmail.com.
Raysa Moreira Aprígio, Email: raysaprigio@gmail.com.
Carlos Eduardo Rocha, Email: drcarlosrocha@hotmail.com.
Daniel Gregório Gonsalves, Email: danielgregoriogonsalves@gmail.com.
Dionei Freitas de Morais, Email: dionei.fm@terra.com.br.
Paulo Henrique Pires de Aguiar, Email: phpaneurocir@gmail.com.
Feres Chaddad-Neto, Email: fereschaddad@hotmail.com.
Ethical approval:
The research/study approved by the Institutional Review Board at FACULDADE DE MEDICINA DE SÃO JOSE DO RIO PRETO - FAMERP, number 7.469.434, dated March 27, 2025.
Declaration of patient consent:
Patient’s consent not required as there are no patients in this study.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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