The Importance of Intratumoral Venous Drainage Preservation in Two-Stage Surgery of Large Hypervascular Choroid Plexus Papilloma: A Case Report.

Two-stage surgery may be necessary when total tumor removal cannot be accomplished in the first surgery; however, the extent and condition in which the remaining tumor should be before the next surgery have not yet been established. There is a risk of postoperative hemorrhage in the residual tumor, especially in hypervascular tumors. We report a case of hypervascular choroid plexus papilloma (CPP) in a 22-year-old male patient where the preservation of intratumoral venous drainage was considered important to avoid hemorrhagic complications during a two-stage surgery. In the first surgery, it was difficult to control the bleeding from the debulked tumor, and the surgery was terminated due to severe blood loss. Large draining veins running in the tumor were preserved as it was suspected that these were important drainage routes of the bloodstream of the tumor. The preserved draining red veins changed to normal venous color in the second surgery performed after one week. The residual tumor was not vascularized during the second surgery and underwent gross total resection with less blood loss. The patient was discharged without sequelae. There was no recurrence of the tumor and no neurological deficit during the three-year follow-up. To prevent postoperative hemorrhage associated with a residual tumor, it may be important to preserve venous drainage of the tumor in hypervascular tumor resection.