Migrating Lateral Ventricle Choroid Plexus Cyst into the Fourth Ventricle Causing Acute Hydrocephalus

Abstract

Choroid plexus cysts consist of abnormal folds of the choroid plexus that typically resolve prior to birth. Rarely, these cysts persist and may cause outflow obstruction of cerebrospinal fluid. In this article, we presented a 5-month-old male child patient who presented with lethargy, vomiting, and a bulging anterior fontanelle. Magnetic resonance imaging showed one large choroid plexus cyst had migrated from the right lateral ventricle through the third ventricle and cerebral aqueduct into the fourth ventricle causing outflow obstruction. The cyst was attached to the lateral ventricle choroid plexus by a pedicle. The cyst was endoscopically retrieved from the fourth ventricle intact and then fenestrated and coagulated along with several other smaller cysts. Histologic examination confirmed the mass was a choroid plexus cyst. The patient did well after surgery and did not require any cerebrospinal fluid diversion. Nine months after surgery, the patient continued to thrive with no neurological deficits. This case is the first we have found in the literature of a lateral ventricular choroid plexus cyst migrating into the fourth ventricle and the youngest of any migrating choroid plexus cyst. Only three other cases of a migrating choroid plexus cyst have been documented and those only migrated into the third ventricle. New imaging advances are making these cysts easier to identify, but may still be missed on routine sequences. High clinical suspicion for these cysts is necessary for correct treatment of this possible cause of hydrocephalus.

Keywords

choroid plexus cyst - hydrocephalus - endoscopy - case report

Publication History

Received: 16 December 2020

Accepted: 01 January 2021

Article published online:
17 February 2021

• References

• 1 Ostlere SJ, Irving HC, Lilford RJ. Fetal choroid plexus cysts: a report of 100 cases. Radiology 1990; 175 (03) 753-755
• 2 Walkinshaw SA. Fetal choroid plexus cysts: are we there yet?. Prenat Diagn 2000; 20 (08) 657-662
• 3 Lam AH, Villanueva AC. Symptomatic third ventricular choroid plexus cysts. Pediatr Radiol 1992; 22 (06) 413-416
• 4 Kraus I, Jirásek JE. Some observations of the structure of the choroid plexus and its cysts. Prenat Diagn 2002; 22 (13) 1223-1228
• 5 Fong K, Chong K, Toi A, Uster T, Blaser S, Chitayat D. Fetal ventriculomegaly secondary to isolated large choroid plexus cysts: prenatal findings and postnatal outcome. Prenat Diagn 2011; 31 (04) 395-400
• 6 Petrikovsky BM, Terrani M, Sichinava LG. Natural history and clinical significance of multiple cysts in a single choroid plexus. J Diagn Med Sonogr 2018; 34 (06) 481-483
• 7 Bernier FP, Crawford SG, Dewey D. Developmental outcome of children who had choroid plexus cysts detected prenatally. Prenat Diagn 2005; 25 (04) 322-326
• 8 Norton KI, Rai B, Desai H, Brown D, Cohen M. Prevalence of choroid plexus cysts in term and near-term infants with congenital heart disease. AJR Am J Roentgenol 2011; 196 (03) W326-9
• 9 Riebel T, Nasir R, Weber K. Choroid plexus cysts: a normal finding on ultrasound. Pediatr Radiol 1992; 22 (06) 410-412
• 10 Nahed BV, Darbar A, Doiron R, Saad A, Robson CD, Smith ER. Acute hydrocephalus secondary to obstruction of the foramen of Monro and cerebral aqueduct caused by a choroid plexus cyst in the lateral ventricle. Case report. J Neurosurg 2007; 107 (3, Suppl): 236-239
• 11 Spennato P, Chiaramonte C, Cicala D. et al. Acute triventricular hydrocephalus caused by choroid plexus cysts: a diagnostic and neurosurgical challenge. Neurosurg Focus 2016; 41 (05) E9
• 12 Andreussi L, Cama A, Cozzutto C, Gianbartolomei G, Grossi G. Cyst of the choroid plexus of the left lateral ventricle. Surg Neurol 1979; 12 (01) 53-57
• 13 Parízek J, Jakubec J, Hobza V. et al. Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child. Childs Nerv Syst 1998; 14 (12) 700-708