Complications of Therapy for Supratentorial Choroid Plexus Tumors in Children

Surgery

Mortality

• 0–10% current mortality rate: Before 1975 the surgical mortality rate associated with surgery on these tumors was 25–45% (49).  Since 1975, series have reported a reduction in this rate to 0–10% (higher for tumors located in the third and fourth ventricles than for tumors in the lateral ventricle) (36, 50, 52).
• Exsanguination: Deaths intraoperatively due to uncontrollable bleeding have been described (52, 4)

Morbidity

• 30% rate of complications: Reported for 26–30% of cases (25, 52).
• Brain collapse: Brain collapse after the removal of the tumor is the second complication reported (49) and is inversely proportional to the thickness of the cortical mantle. It in turn can lead to subdural effusions, hematomas, or intraparenchymal hemorrhage (55).
• Seizures: Seizures are reported in 29–70% of patients requiring a transcortical approach (49). Treatment with anticonvulsants usually awaits their occurrence, and prophylaxis is generally not needed.
• Hemiparesis: Deficits can arise from the approach (i.e., corticectomy or retraction on the motor cortex), as well as during the resection when the tumor is adherent to the lateral wall of the ventricle (and entering the internal capsule when trying to remove the tumor completely). The coagulation of the anterior choroidal artery, when trying to cut the blood supply of the tumor, can also lead to hemiparesis.
• Visual deficits: Quadrantanopsia or hemianopsia may result from interruption of the visual tracts.
• Brainstem/cerebellar dysfunction: This complication may arise with tumors in the fourth ventricle that are adherent to the floor.
• Memory deficits: This complication may arise with lateral ventricular tumors adherent to the fornix, or when there is a fornix injury during the approach to a tumor in the third ventricle.
• Developmental delay/neuropsychological deficits: In young children the presentation of the tumor might be developmental delay, which might not recover postoperatively.

Medical

• Complications expected for chemotherapy: The usual complications of chemotherapy may occur, such as neutropenia, infection, and the like.

Radiation

• Age-limited use: Because of the risk of radiation in children younger than 3 to 4 years, younger patients receive chemotherapy first and then might undergo radiation therapy after they reach the age of 3 to 4 years.