Adult-onset fourth ventricular choroid plexus papilloma: Telovelar approach and post-operative outcome

Choroid plexus papillomas (CPPs) are rare, benign intraventricular tumours, predominantly affecting children. Adult-onset CPPs are uncommon but usually arise in the fourth ventricle and present with features of obstructive hydrocephalus and cerebellar signs. We report a case of a 42-year-old male with progressive truncal ataxia, raised intracranial pressure-type headache, and visual decline. Imaging revealed a posterior fossa mass causing obstructive hydrocephalus. Differential diagnoses included ependymoma, medulloblastoma and dermoid cyst. The patient underwent midline suboccipital craniotomy with near-total tumour excision, with intraoperative external ventricular drainage, followed by ventriculoperitoneal shunt placement later. Histopathology confirmed CPP. Postoperative complications included lower cranial nerve dysfunction requiring tracheostomy. The patient gradually improved and was successfully decannulated. At 6-month follow-up, he had a stable small residual tumour with no progression. Although rare in adults, CPP should be considered in the differential diagnosis of posterior fossa tumours presenting with cerebellar signs and raised ICP. Surgical excision remains the mainstay of treatment, with the extent of resection being a key prognostic factor. Near-total resection may be appropriate when tumour adherence to critical structures risks significant morbidity, and continued radiological follow-up is essential to monitor for recurrence.