Embolization of a pediatric choroid plexus papilloma as a stand-alone treatment strategy: illustrative case

BACKGROUND: In this case report, the authors describe a rare case in which embolization of a pediatric choroid plexus papilloma (CPP) functioned as definitive management rather than a preoperative complement. OBSERVATIONS: A 14-month-old boy underwent evaluation for macrocephaly and developmental delay and was found to have a 2.6-cm avidly enhancing intraventricular mass centered in the temporal horn of the left lateral ventricle with extension into the atrium, radiographically most consistent with CPP. Diagnostic cerebral angiography demonstrated predominant supply from the left anterior choroidal artery. The lesion underwent endovascular embolization with Onyx-18, achieving complete angiographic devascularization without procedural complication. Planned resection was initially deferred because of intercurrent rhinovirus/enterovirus infection in the acute postprocedural period and the favorable embolization result. Serial follow-up imaging demonstrated a progressive decrease in lesion size and enhancement, followed by radiographic stability of a small treated residual lesion without evidence of dissemination or new complication. The patient remained neurologically stable throughout follow-up. LESSONS: Although resection remains the standard treatment for CPP, stand-alone embolization may represent a feasible strategy in highly selected circumstances, provided that close long-term surveillance is maintained. https://thejns.org/doi/10.3171/CASE26348.