Case Of Choroid Plexus Papilloma Research Articles

Posterior Fossa Tumors: Special Issue

This edition of APN is entirely dedicated to posterior fossa tumors. Very common in the daily routine of pediatric neurosurgeons, these tumors remain one of the most challenging pathologies we must face. The importance and complexity of the anatomical structures of the posterior fossa, associated with the enormous histological variety of neoplastic lesions in this region, make its therapeutic approach difficult and even more challenging. The degree of surgical resection plays a determining role in the prognosis and cure possibilities for the children with posterior fossa tumors; on the other hand, gross total resection is related to the much feared cerebellar mutism syndrome, related to serious cognitive and behavioral sequelae. Every pediatric neurosurgeon's nightmare, this subject deserves special attention in our edition. Ballestero and Juca review the literature, discuss the concepts of mutism, predisposing factors, pathophysiology, and available treatments.
 However, mutism prevention after surgical resection is essential. In addition to excellent mastery of microneurosurgery techniques and in-depth anatomical knowledge of the structures of the posterior fossa, pediatric neurosurgeons must use all the most advanced technologies to protect their patients and obtain the best results. Therefore, Kodangeski and Pinheiro discuss the use of electrophysiological monitoring during resection surgeries for posterior fossa tumors. Ahmed also emphasizes the importance of neuronavigation in these surgeries, as a significant tool to reduce morbidity and mortality.
 Around 70 to 90% of posterior fossa tumors present with hydrocephalus. The treatment of hydrocephalus before, during or after tumor resection is a very controversial subject, with different approaches among groups. Mandic retrospectively applies the success scores of endoscopic third ventriculocysternostomy in a group of patients with posterior fossa tumors and analyzes its efficiency.
 Costa pays special attention to posterior fossa ependymomas. Despite the explosion of genomic and epigenomic knowledge of these tumors in recent decades, surgery still plays an essential role in their treatment because the main objective as gross total resection represents a great technical challenge for the neurosurgeon.
 Besides to medulloblastomas, astrocytoma and ependymomas, more rarely other histological types can involve the posterior fossa and should be considered as differential diagnosis of these lesions. Therefore, Lopez presents clinical cases of choroid plexus papilloma and Rabelo Rodrigues reviews the cases of hemangioblastomas found in the literature.
 Even though posterior fossa tumors are predominant in children of preschool and school age, Dassi presents a series of cases in patients under two years of age, highlighting the histological characteristics and treatment strategies in this age group.
 The final result of this edition is a set of articles that highlight the complexity of posterior fossa tumors and the challenges of their treatment. Although these are the most common intracranial tumors in childhood and are part of the routine of every pediatric neurosurgery service, the war against those tumors has not been definitively won. We still lack greater understanding, and the exchange of experiences is increasingly necessary. We hope these articles can help all readers in their daily battles.
 Our special thanks to all the authors who worked on this edition and to the editorial staff who, with all their dedication, made it possible.
 Have an excellent read!

A case report of hydrocephalus due to diffuse villous hyperplasia of the choroid plexus: surgical treatment by combination a flexible videoscope with a rigid endoscope.

Diffuse villous hyperplasia of the choroid plexus (DVHCP) and choroid plexus papilloma (CPP) are rare benign tumors usually diagnosed as a result of progressive hydrocephalus, especially in childhood. We present the case of a Japanese boy diagnosed with progressive hydrocephalus due to DVHCP. Case: A 2-year and 3-month-old Japanese boy was found to have delayed motor development (equivalent to 1year and 2months old), an enlarged head circumference of 51cm within + 1.5 standard deviation (S.D.), and incomplete closure of the anterior fontanel. The magnetic resonance imaging (MRI) showed lobular enlargement of the bilateral choroid plexuses extending from the trigone to the body and inferior horn of the lateral ventricle. The endoscopic choroid plexus coagulation surgery was performed to reduce the CSF formation rate. DVHCP was diagnosed both pathologically and clinically. Postoperatively, the patient progressed without complications, such as cerebrospinal fluid leakage. Although ventricular enlargement persisted, the anterior fontanel recessed, and the expansion of the head circumference stopped. Few cases of bilateral DVHCP and CPP have been reported in the literature. We encountered a case in which effective choroid plexus coagulation was performed for hydrocephalus due to DVHCP using less invasive endoscopic technique. It also represented an association between DVHCP and the gain of chromosome 9p.

Our Experience of Posterior Fossa Tumors Surgeries

Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes.
 Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically.
 Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery.
 Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.

Clinico-radiological diagnosis of silent Choroid plexus papilloma in a child

Background: Choroid plexus papillomas (CPPs) are benign slow-growing tumors with the most common site as the choroid plexus of the lateral ventricle in children. These are highly vascular solid tumors which have classical diagnosis in contrast-enhanced computerized tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). These require early management because of their secondary symptoms related to hydrocephalus and others due to tumoral compression. Case Report: We present a 10-month-old male child with abnormal eye movements and fever following head trauma seventeen days before. Ultrasound of the brain revealed the hyperechoic mass in the right lateral ventricle. CECT and CEMRI diagnosed as a case of choroid plexus papilloma with gross hydrocephalus. This was a silent CPP which came to limelight following head trauma. Ventriculoperitoneal shunt was placed for the decompression of the ventricular system and was advised for subsequent surgical management. Conclusion: Atypical presentations of CPP can confuse in making the diagnosis and this delay can be harmful to the patient. Early diagnosis of CPP is very important as these are slow-growing tumors which can lead to various complications if late diagnosis is made. Cross-sectional modalities such as CECT and CEMRI are the most valuable diagnostic modality tools for the early diagnosis

A Rare Case of Choroid Plexus Papilloma of the Third Ventricle in an Adult

Colloid cysts are the commonest masses of the third ventricle. Third ventricle neoplasms are uncommon. They include tumors arising from the choroid plexus (papillomas, carcinomas), tumors arising from other than the choroid plexus (ependymomas, meningiomas), metastases, and lymphoma. Choroid plexus tumors usually occur in the lateral ventricle in children and fourth ventricle in adults, and often present with hydrocephalus. We herein describe the extremely rare occurrence of third ventricle choroid plexus papilloma in a 35-year-old man who presented to the emergency department with a long history of intermittent headaches, occasionally associated with photophobia. CT and MR imaging revealed a lobulated ovoid lesion in the third ventricle with minimal extension into the right lateral ventricle through the foramen of Monro, causing mild ventricular dilatation. Surgical resection was performed and histopathology revealed choroid plexus papilloma.

Telovelar approach for microsurgical resection of an unusually located choroid plexus papilloma in the luschka foramen of an infant – Case report and review of literature

BackgroundChoroid plexus tumors are rare intraventricular tumors. Most of these tumors are benign choroid plexus papillomas. Most common location of these tumors in pediatric population is lateral ventricle although posterior fossa located tumors are also reported. Tumors located within luschka foramen extending to cerebellopontine angle are extremely rare in this age. So, there are little data in the literature regarding optimal management and surgical approach of these tumors within this challenging location. Case descriptionWe present an extremely rare case of choroid plexus papilloma of luschka foramen in an 8 months old boy extended laterally to cerebellopontine angle and pontomedullary junction. Tumor was resected successfully through telovelar approach without posing any injury to cerebellum, brainstem or cranial nerves. We also performed a review of limited literature available around different aspects of these tumors. ConclusionChoroid plexus papillomas of luschka foramen in pediatric population, although rare, can be effectively resected through telovelar approach without posing any neurological sequels to patient.

A Case of Choroid Plexus Papilloma with Rare Location Presenting with Impaired Consciousness

A Case of Choroid Plexus Papilloma with Rare Location Presenting with Impaired Consciousness

Choroid Plexus Papilloma with Dandy Walker Variant: Co-existence or Association- A Case Report

Choroid plexus tumors are rare intracranial tumors which account for 0.4-0.6% of all brain tumors. Choroid plexus tumors represent a spectrum of neoplasms derived from papillary epithelium of normal choroid plexus, including well-differentiated papilloma (WHO grade I), intermediate form as atypical Choroid Plexus Papilloma (WHO grade II) and highly aggressive choroid plexus carcinomas (WHO grade III). Though rare, it is responsible for the communicating hydrocephalus in children due to overproduction of cerebrospinal fluid. Due to advances in molecular biology and better understanding of the tumorigenesis of choroid plexus papilloma, now it is established that several genetic syndromes and central nervous sytem abnormalities are associated with this tumor. Here, we reported a case of a 10 months old child who presented with sudden deterioration of consciousness level and after thorough evaluation, diagnosed as a case of Choroid Plexus Papilloma with Dandy Walker Variant. Till date, this is the first reported case of the association/ co-existence of such two conditions which needs further evaluation.
 Bangladesh Med J. 2017 May; 46 (2): 61-65

The clinical application of the telovelar approach in tumor resection of the fourth ventricle

Objective To investigate the safety of telovelar approach for removing the fourth ventricle tumors. Methods The clinical data of 30 patients with fourth ventricle tumors was analyzed from July, 2012 to July, 2017 in our hospital. All patients were treated through telovelar approach. Results 25 cases had total tumor resection and 5 cases had subtotal resection. 24 cases recovered well after operation [Glasgow treatment outcome classification (GOS): 5 points]. 4 cases suffered from facial numbness and deviated mouth (GOS: 4 points), limb hemiparesis occurred in one case (GOS: 3 points). One patient died from pulmonary infection (GOS: 1 points). None of the survived patients underwent reticence, and the follow-up duration was 2 to 40 months. No obvious tumor recurrence occurred. Pathology results confirmed: 12 cases of ependymoma, 5 cases of astrocytoma, 2 cases of arachnoid cyst, 2 cases of medulloblastoma, 2 cases of choroid plexus papilloma, 2 cases of metastatic carcinoma, 2 cases of central neurocytoma, 2 cases of hemangioblastoma and 1 case of cavernous hemangioma. Conclusion Resection of the fourth ventricle tumors is very difficult. The tumors can fully be exposed through telovelar approach which avoiding the incision of the vermis and reducing the complications. Key words: Telovelar approach; Fourth ventricle tumors; Total tumor resection; Safety

Pathogenic implications of cerebrospinal fluid barrier pathology in neuromyelitis optica

Pathogenic autoantibodies associated with neuromyelitis optica (NMO) induce disease by targeting aquaporin-4 (AQP4) water channels enriched on astrocytic endfeet at blood–brain interfaces. AQP4 is also expressed at cerebrospinal fluid (CSF)–brain interfaces, such as the pial glia limitans and the ependyma and at the choroid plexus blood–CSF barrier. However, little is known regarding pathology at these sites in NMO. Therefore, we evaluated AQP4 expression, microglial reactivity, and complement deposition at pial and ependymal surfaces and in the fourth ventricle choroid plexus in 23 autopsy cases with clinically and/or pathologically confirmed NMO or NMO spectrum disorder. These findings were compared to five cases with multiple sclerosis, five cases of choroid plexus papilloma, and five control cases without central nervous system disease. In the NMO cases, AQP4 immunoreactivity was reduced relative to control levels in the pia (91%; 21/23), ependyma (56%; 9/16), and choroid plexus epithelium (100%; 12/12). AQP4 immunoreactivity was normal in MS cases in these regions. Compared to MS, NMO cases also showed a focal pattern of pial and ependymal complement deposition and more pronounced microglial reactivity. In addition, AQP4 loss, microglial reactivity, and complement deposition colocalized along the pia and ependyma only in NMO cases. Within the choroid plexus, AQP4 loss was coincident with C9neo immunoreactivity on epithelial cell membranes only in NMO cases. These observations demonstrate that NMO immunopathology extends beyond perivascular astrocytic foot processes to include the pia, ependyma, and choroid plexus, suggesting that NMO IgG-induced pathological alterations at CSF–brain and blood–CSF interfaces may contribute to the occurrence of ventriculitis, leptomeningitis, and hydrocephalus observed among NMO patients. Moreover, disruption of the blood–CSF barrier induced by binding of NMO IgG to AQP4 on the basolateral surface of choroid plexus epithelial cells may provide a unique portal for entry of the pathogenic antibody into the central nervous system.

Choroid Plexus Papillomas of the Cerebellopontine Angle

Choroid plexus papillomas (CPPs) of the cerebellopontine angle (CPA) are extremely rare. We present a series of 21 cases operated on in the last 7 years at our institution. During the period from January 2008 to October 2015, we encountered 102 histologically established cases of CPPs, of which 21 were located in the CPA region. Clinical profiles, radiologic features, surgical procedures, intraoperative findings, and outcomes were extracted from the patient records and neuroimaging data. The 21 CPPs in the CPA region accounted for 20.5% of all CPPs. Two of the tumors occurred in pediatric patients. Tumor size was 2.5-4.7 cm. The rate of calcification was higher in the CPPs in the CPA region. Peritumoral cysts and cysts with small nodules were observed in our cases. A far lateral suboccipital approach was chosen for CPPs protruding inferiorly into the foramen magnum region (n= 14), and a suboccipital retrosigmoid approach was chosen for the other tumors. Total resection was achieved in 18 patients, and subtotal resection was achieved in 3 patients. During the follow-up period, only 1 patient experienced recurrence 32 months after the first operation. The recurrence turned out to be an atypical CPP. CPPs in the CPA region cannot be easily differentiated from other tumors preoperatively. Cysts and calcifications appear on neuroimaging. CPPs in the CPA region usually protrude inferiorly into the foramen magnum region. As much tumor should be removed as possible to avoid recurrence and malignant transition.

Papiloma de plexo coróide em cão adulto – relato de caso

This article describes a case of choroid plexus papilloma in a four-year-old male chow-chow that presented a seven-week-long history of chronic and progressive incoordination and neck pain. Neurologic examination disclosed progressive cerebellar and vestibular manifestations. Postmortem examination revealed a non-encapsulated asymmetric hemorrhagic mass situated within the fourth ventricle, which expanded towards the cerebellum and cranial spinal cord segments. The neoplasm was diagnosed as choroid plexus papilloma (CPP) by histopathological evaluation. The present report aims to describe the occurrence of CPP, which is uncommonly diagnosed, and to reaffirm the importance of including intracranial neoplasms in the differential diagnosis of young patients with neurological disorders.

Clinicopathologic study of endolymphatic sac tumor (ELST) and differential diagnosis of papillary tumors located at the cerebellopontine angle.

We investigated the clinicopathologic features and immunophenotypes of 10 cases of endolymphatic sac tumor (ELST) and compared them with other papillary tumors, including eight cases of choroid plexus papilloma (CPP), three cases of atypical choroid plexus papilloma (ACPP), two cases of papillary ependymoma (PE), three cases of papillary meningioma (PM) and two cases of metastatic carcinoma (MC) the at cerebellopontine angle (CPA). The age at onset of ELST ranged from 13 to 39 years. The male-to-female ratio was 1:1. The clinical presentations were primarily ear-related symptoms. The temporal bones showed extensive destruction. Histologically, the important characteristics for differential diagnosis with CPP, which is most similar to ELST, include the quantity of blood vessels, the nuclei location at apical surface of the papillary, clear cytoplasm cells sometimes with visible vacuoles, psammoma bodies and dura or bone invasion. Immunohistochemistry stains for AE1/AE3, cytokeratin CK)5/6, epithelial membrane antigen, CK8/18, S-100, and synaptophysin are helpful in diagnosis of ELST. In ELST, ultrastructure of uniform 2 μm vesicles in cytoplasm was seen, and gene analysis also showed missense mutation in exon 3. This study indicates that the above histological features combined with immunohistochemistry findings are important for making the correct diagnosis. Gene analysis should be used in patients without medical history to exclude von Hippel-Lindau disease.

Case series of choroid plexus papilloma in children at uncommon locations and review of the literature

Background:Choroid plexus papillomas (CPPs) comprise around 1% of intracranial neoplasms. The most common location is atrium of the lateral ventricle in children and fourth ventricle in adults. Other rare locations include third ventricle, cerebellopontine (CP) angle and cerebral parenchyma, with only a few cases reported. Authors report three cases of CPP at uncommon locations in pediatric patients. The rarity of these locations, diagnostic dilemma and management aspects are discussed along with an extensive review of the literature.Methods:Retrospective institutional data analysis of histopathologically confirmed pediatric CPPs from 2010 to 2014.Results:Authors noted three cases of CPP in children in uncommon locations-one each in the posterior third ventricle, fourth ventricle, and CP angle. All were males in the first decade. Two cases presented with features of obstructive hydrocephalus while the latter presented with compressive effects. Complete excision was achieved in two cases while subtotal removal was performed in one case (fourth ventricular) because of excess blood loss. Mean follow-up duration was 24.6 months (range 20–30 months). One case (of subtotal removal) had fair recovery while other two had excellent outcomes.Conclusions:Posterior third ventricle, fourth ventricle, and CP angle are uncommon locations for these tumors in children. Complete surgical removal is the treatment of choice and approach needs to be tailored according to the site and size of the lesion. Blood loss is a major concern in young children as they are highly vascular tumors. Complete removal leads to excellent long-term survival rates. Adjuvant treatment is not required.

Atypical Choroid Plexus Papilloma Treated with Single Agent Bevacizumab

Choroid plexus papillomas (CPPs) are usually not malignant and occur in less than 1% of brain tumors in patients of all ages. They represent 3% of childhood intracranial neoplasms with a predilection in younger ages. Papillomas have an indolent course and carry a good long-term outcome if gross total surgical resection is achieved. However malignant evolution may occur, with a 10-30% incidence. Chemotherapy has been used with varied degrees of success. Most series are very small, some are only limited to case reports and cannot lead to guidelines or therapeutic recommendations. We are reporting the first case of recurrent CPP treated with 5 mg/kg of bevacizumab administered once every two weeks. Complete patient evaluations with follow-up contrast-enhanced magnetic resonance imaging (MRI) scans were obtained after the initial two treatments and every 8 weeks thereafter. Only after two treatments, the MRI scans showed radiological stabilization of the tumor, and the patient achieved an excellent clinical response with significant resolution of all skin lesions.

A Case of Difficult Management of Fluid-electrolyte Imbalance in Choroid Plexus Papilloma

A 22-month-old boy presented with nausea and gradual deterioration of gait disturbance. Computed tomography (CT) demonstrated an intraventricular mass lesion in the right lateral ventricle. He was referred to our department 3 weeks after onset. Acute hydrocephalus gradually proceeded 4 days after admission, and external ventricular drainage (EVD) was performed. EVD revealed cerebrospinal fluid (CSF) overproduction (800-1,500 mL/day) under constant pressure of 10 cm H2O above external auditory meatus. Magnetic resonance imaging showed a multi-lobular mass in the inferior horn of the right lateral ventricle. A choroid plexus tumor was suspected. The ratio of blood urea nitrogen:creatinine (BUN:Cre) remained between 30 and 40, and hemoglobin was between 14.0-17.0 mg/dL, suggesting marked dehydration. Serum sodium varied between 117 and 140 mmol/L, and serum potassium between 2.2 mmol/L and 6.9 mmol/L. The amount of EVD was unstable and fluid balance management was difficult. Hypotonic fluid with sodium chloride supplement was used to adjust the fluid and electrolyte imbalance. Surgical removal of the tumor was performed 6 days after EVD and tumor was grossly and totally removed. The high BUN:Cre ratio decreased to about 15 and hemoglobin recovered to 7.5-9.0 mg/dL after removal. Electrolytes returned to the normal range. Overproduction of CSF also markedly improved to < 300 mL/day. Histopathological examination diagnosed choroid plexus papilloma.We experienced a case of choroid plexus papilloma associated with fluid-electrolyte imbalance due to over-drainage after EVD, which could not be effectively controlled before tumor removal. Cautious fluid management and emergent surgical resection might be required to manage the overproduction of CSF and fluid-electrolyte imbalance.

Choroid plexus papilloma in a girl with hypomelanosis of Ito

The authors report a case of choroid plexus papilloma in a girl with hypomelanosis of Ito, and they review the literature in brief. Hypomelanosis of Ito is a rare neurocutaneous syndrome characterized by cutaneous hypopigmented whorls, streaks, and patches along lines of Blaschko. Most patients exhibit CNS manifestations, including psychomotor retardation, seizures, hypotonia, and ataxia. A 6-year-old girl with hypomelanosis of Ito was referred to the authors' hospital with bilateral tumors in the lateral ventricles. The right lateral ventricle tumor was surgically removed. Immunohistochemical investigations revealed the tumor to be a choroid plexus papilloma (WHO Grade I). A chromosomal investigation revealed that the tumor tissue demonstrated a large loss of heterozygosity at chromosome 10. The case reported here serves as a reminder that de novo brain tumors may arise in patients with chromosomal mosaicism.

Endoscopic coagulation of choroid plexus hyperplasia

Hydrocephalus is a clinical disorder resulting from an imbalance between the production of CSF and its resorption, of which the latter is mostly a disadvantage. In rare cases of choroid plexus papilloma or carcinoma, hydrocephalus is due to an overproduction of CSF. Choroid plexus hyperplasia (CPH) is a distinct clinicopathological entity in which the enlarged choroid plexus produces large amounts of CSF. Historically, patients with CPH were treated by shunt procedures or by microsurgical removal of the choroid plexus, which is associated with a high complication rate. In this paper the authors show that endoscopic plexus coagulation can result in restoring the equilibrium of the intracranial fluid volumes, resulting in shunt independency. In this way, both the shunt-related complications and the bleeding risks of microsurgical plexectomy are avoided. In instances of hydrocephalus, thorough efforts should be made to demonstrate the underlying pathophysiology to choose the optimal treatment, of which shunt procedures should receive the least priority.

A case of choroid plexus papilloma with stromal sclerosis and indistinct papillary structures

We present a case of choroid plexus papilloma with unusual histopathological findings. A 41-year-old Japanese man presented with dizziness. Brain magnetic resonance imaging scan showed a distinct mass in the fourth ventricle. Histopathological examination showed proliferation of cuboidal cells forming irregular trabeculae, small nests, and pseudoglandular and indistinct papillary structures, accompanied by a variable degree of stromal sclerosis. The tissue sections also showed rare mitotic activity, no hypercellularity, cellular pleomorphism, or necrosis. The immunohistochemical findings were tumor cells positive for cytokeratin 7, vimentin, S-100 protein, and transthyretin but negative for cytokeratin 20, BerEP4 and carcinoembryonic antigen. These findings were consistent with choroid plexus papilloma. The combination of these immunohistochemical markers was helpful in establishing the diagnosis, although the morphological finding of stromal sclerosis is rare for choroid plexus papilloma.

Combined Staged Endoscopic and Microsurgical Approach of a Third Ventricular Choroid Plexus Papilloma in an Infant

Choroid plexus papillomas of the third ventricle in newborn infants are quite rare and present a significant surgical challenge. This case report illustrates the utility of endoscopy in facilitating tumor resection. A 6-week-old boy, born prematurely at a gestational age of 35 weeks, presented with hydrocephalus secondary to a choroid plexus papilloma in the third ventricle, extending to the aqueduct of Sylvius and into the fourth ventricle. On admission, he was found to have clinical signs of raised intracranial pressure. MRI revealed a homogeneously enhancing mass primarily in the third ventricle. The initial surgical procedure was insertion of a ventriculo-peritoneal shunt, followed by an endoscopic biopsy, which allowed the surgeons to mobilize the tumor into the right lateral ventricle. This facilitated a subsequent transcortical approach to completely remove the tumour. The authors present a case of choroid plexus papilloma in an uncommon location with a unique surgical approach and a successful outcome with no neurological deficits. We detail our surgical approach and the complexity of approaching a tumor located in the third ventricle of an infant.