J Korean Med Sci.  2005 Apr;20(2):335-339. 10.3346/jkms.2005.20.2.335.

Neuroendoscopic Removal of Large Choroid Plexus Cyst: A Case Report

• Jeon JH
• Lee SW
• Ko JK
• Choi BG
• Cha SH
• Song GS
• Choi CH

• KMID: 1095216
• DOI: http://doi.org/10.3346/jkms.2005.20.2.335

Abstract

Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts, occuring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.

Keyword

Choroid Plexus Neoplasms; Endoscopy; Surgical Procedures, Minimally Invasive

MeSH Terms

Adult
Brain Diseases/diagnosis/pathology/*surgery
*Choroid Plexus
Cysts/diagnosis/pathology/*surgery
Endoscopy
Humans
Male

Figure

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  Fig. 1 Preoperative computed tomographic scan demonstrating only asymmetry of the lateral ventricles, with enlargement of the right lateral ventricle.

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  Fig. 2 Preoperative MR images demonstrate a large cystic lesion occupying almost completely the enlarged right lateral ventricle with CSF-like signal intensity and a unilateral right-sided hydrocephalus with deviation of the septum pellucidum to the left. (A) T2-weighted axial image. (B) T1-weighted coronal image.

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  Fig. 3 (A) Intraoperative image reveals whitish wall of cyst obstructing the right foramen of Monro completely. (B) After the midportion of the cyst wall above the foramen of Monro was fenestrated, cystic fluid was expelled.

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  Fig. 4 Gross photographic finding of extracted choroid plexus cyst.

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  Fig. 5 Photomicrographs. Staining of the cyst lining shows a low cuboidal epithelium with a subadjacent collagenous wall. The morphological feature of the epithelium is consistent with choroid epithelium (H&E, ×200).

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  Fig. 6 A CT scan obtained 14 days after endoscopic removal of the cyst reveals decreased right lateral ventricle.

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