Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series

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Their variable presentation and surgical challenges, particularly in pediatric patients, make detailed institutional experiences valuable for guiding management and understanding outcomes. Methods We retrospectively reviewed all patients treated for CPTs at the Neurosurgery Department of Habib Bourguiba University Hospital between January 2010 and December 2023. Clinical, radiological, surgical, histopathological, and outcome data were analyzed. Imaging included CT and MRI; histopathology assessed cellularity, pleomorphism, mitotic activity, necrosis, and immunohistochemistry. Surgical approach, cerebrospinal fluid diversion, perioperative complications, adjuvant therapy, and long-term outcomes were recorded. Results Seven patients were included (median age 2 years, range 2 months–28 years; 5 females). Histology revealed four choroid plexus papillomas (CPPs) and three choroid plexus carcinomas (CPCs). Tumor locations were lateral ventricles (n=5), third ventricle (n=1), and fourth ventricle/CPA (n=1). Gross total resection was achieved in all CPPs, with favorable long-term outcomes and minimal morbidity. CPCs were more vascular and complex to resect; one patient died intraoperatively, another shortly postoperatively, and the third developed severe postoperative complications before adjuvant therapy. Ki-67 indices ranged from <1% in CPPs to 40% in CPCs. CSF diversion was required in two patients. Conclusions CPTs demonstrate considerable heterogeneity in presentation, histology, and outcomes. Complete surgical resection is associated with excellent prognosis in CPPs, whereas CPCs present greater surgical and postoperative challenges. This series underscores the importance of early diagnosis, careful surgical planning, and multidisciplinary management to optimize outcomes across the CPT spectrum. 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F1000Research 2026, 15 :212 ( https://doi.org/10.12688/f1000research.176833.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Clinical Practice Article Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] Maïla Bounemra https://orcid.org/0000-0002-0088-7823 1 , Fatma Kolsi 1 , Saadia Makni https://orcid.org/0000-0002-8526-881X 2 , Imen Dammak 1 , Mohamed Zaher Boudawara 1 Maïla Bounemra https://orcid.org/0000-0002-0088-7823 1 , Fatma Kolsi 1 , [...] Saadia Makni https://orcid.org/0000-0002-8526-881X 2 , Imen Dammak 1 , Mohamed Zaher Boudawara 1 PUBLISHED 09 Feb 2026 Author details Author details 1 Department of Neurosurgery, Habib Bourguiba Hospital, Sfax, Sfax, 3029, Tunisia 2 Department of Pathology, Habib Bourguiba Hospital, Sfax, Sfax, 3029, Tunisia Maïla Bounemra Roles: Conceptualization, Formal Analysis, Writing – Original Draft Preparation Fatma Kolsi Roles: Conceptualization, Project Administration, Supervision, Writing – Review & Editing Saadia Makni Roles: Investigation, Supervision, Validation Imen Dammak Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Mohamed Zaher Boudawara Roles: Supervision OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Choroid plexus tumors (CPTs) are rare intraventricular neoplasms with diverse clinical and histopathological features. Their variable presentation and surgical challenges, particularly in pediatric patients, make detailed institutional experiences valuable for guiding management and understanding outcomes. Methods We retrospectively reviewed all patients treated for CPTs at the Neurosurgery Department of Habib Bourguiba University Hospital between January 2010 and December 2023. Clinical, radiological, surgical, histopathological, and outcome data were analyzed. Imaging included CT and MRI; histopathology assessed cellularity, pleomorphism, mitotic activity, necrosis, and immunohistochemistry. Surgical approach, cerebrospinal fluid diversion, perioperative complications, adjuvant therapy, and long-term outcomes were recorded. Results Seven patients were included (median age 2 years, range 2 months–28 years; 5 females). Histology revealed four choroid plexus papillomas (CPPs) and three choroid plexus carcinomas (CPCs). Tumor locations were lateral ventricles (n=5), third ventricle (n=1), and fourth ventricle/CPA (n=1). Gross total resection was achieved in all CPPs, with favorable long-term outcomes and minimal morbidity. CPCs were more vascular and complex to resect; one patient died intraoperatively, another shortly postoperatively, and the third developed severe postoperative complications before adjuvant therapy. Ki-67 indices ranged from <1% in CPPs to 40% in CPCs. CSF diversion was required in two patients. Conclusions CPTs demonstrate considerable heterogeneity in presentation, histology, and outcomes. Complete surgical resection is associated with excellent prognosis in CPPs, whereas CPCs present greater surgical and postoperative challenges. This series underscores the importance of early diagnosis, careful surgical planning, and multidisciplinary management to optimize outcomes across the CPT spectrum. READ ALL READ LESS Keywords Choroid plexus tumors, Choroid plexus papillomas, Choroid plexus carcinoma, Pediatric neurosurgery, Surgical outcomes, Histopathology, Hydrocephalus Corresponding Author(s) Maïla Bounemra ( [email protected] ) Close Corresponding author: Maïla Bounemra Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Bounemra M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Bounemra M, Kolsi F, Makni S et al. Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :212 ( https://doi.org/10.12688/f1000research.176833.1 ) First published: 09 Feb 2026, 15 :212 ( https://doi.org/10.12688/f1000research.176833.1 ) Latest published: 09 Feb 2026, 15 :212 ( https://doi.org/10.12688/f1000research.176833.1 ) Introduction Choroid plexus tumors (CPTs) are rare intraventricular neoplasms arising from the epithelial cells of the choroid plexus, a structure essential for cerebrospinal fluid (CSF) production and regulation. 1 , 2 Their incidence varies with age, accounting for approximately 1–4% of pediatric brain tumors and 0.4–1% of intracranial tumors in adults. 3 Because of their intraventricular location and frequent CSF overproduction, CPTs commonly cause hydrocephalus and intracranial hypertension, with clinical manifestations depending on tumor size and ventricular site. 3 , 4 Diagnosis is primarily based on magnetic resonance imaging (MRI) and confirmed by histopathological examination. 5 According to the 2021 World Health Organization (WHO) Classification of Tumors of the Central Nervous System (5th edition), CPTs are classified as choroid plexus papilloma (CPP, WHO grade I), atypical choroid plexus papilloma (aCPP, WHO grade II), and choroid plexus carcinoma (CPC, WHO grade III), the latter representing an aggressive malignant entity. 6 , 7 Surgical resection remains the cornerstone of treatment, although management is often challenging because of marked tumor vascularity and complex anatomy, particularly in infants and young children. 8 , 9 Given the rarity of CPTs and the heterogeneity of their presentation and outcomes, we report our institutional experience, focusing on clinical, radiological, histopathological, therapeutic, and outcome-related characteristics. Methods We conducted a retrospective descriptive study including all patients treated for choroid plexus tumors at the Neurosurgery Department of Habib Bourguiba University Hospital (Sfax) between January 2010 and December 2023, regardless of age or sex. Clinical data included age, sex, presenting symptoms, neurological examination findings, and diagnostic delay. Radiological evaluation was based on CT and MRI, assessing tumor location, laterality, ventricular site, parenchymal extension, hydrocephalus, calcifications, mass effect, and contrast enhancement. Surgical variables included time to surgery, preoperative cerebrospinal fluid diversion, surgical approach, intraoperative tumor characteristics, extent of resection, operative duration, and perioperative complications. Histopathological analysis focused on tumor subtype, cellularity, nuclear pleomorphism, mitotic activity, necrosis, solid growth patterns, and immunohistochemical findings. Postoperative outcomes, adjuvant treatments, complications, recurrence, and survival were recorded during follow-up at 3 months, 1 year, and 5 years. Analysis was based on the calculation of medians with ranges for quantitative variables and frequencies for qualitative variables. Results Between January 2010 and December 2023, seven patients with choroid plexus tumors were treated at our institution. Histologically, four tumors were choroid plexus papillomas (CPP) and three were choroid plexus carcinomas (CPC). Median age at diagnosis was 2 years (range: 2 months and 20 days–28 years), with six pediatric patients and one young adult. There was a female predominance (5 females, 2 males). Clinical presentation The median diagnostic delay was 7 days (range: 1 day–2 months). The most frequent presenting symptoms were vomiting (n = 6) and headache (n = 3). Visual disturbances were observed in three patients, seizures in two, and focal neurological deficits or altered consciousness in one patient each. On neurological examination, macrocephaly and sunset gaze were each noted in one infant. Motor deficits were present in two patients, cerebellar signs in one, sixth cranial nerve palsy in one, and papilledema in one. Café-au-lait spots were observed in one patient. Neurological examination was otherwise normal in two cases ( Table 1 ). Table 1. Summary of clinical and radiological data. Obs Age/Sex Clinical features Imaging summary 1 (CPP) 28 F Occipital headache, nausea, diplopia; cerebellar signs, CN V & VI deficits 4th ventricle to CPA, 6×6 cm lesion, cystic + solid, heterogeneous enhancement, triventricular hydrocephalus ( Figure 1 ) 2 (CPP) 2.8 F Holocranial headache, projectile vomiting; clinically normal Left occipital horn of the lateral ventricle, 5×4.7×3.8 cm, isodense, homogeneous enhancement, quadriventricular hydrocephalus ( Figure 2 ) 3 (CPP) 1.75 F Vomiting, altered consciousness (GCS 7/15) Lateral extented to 3rd ventricle 3.7×2.7×2.4 cm, lobulated, hyperdense; cauliflower-like lesion, intense homogeneous enhancement 4 (CPP) 0.17 F Projectile vomiting, feeding refusal, macrocephaly; hypotonia, sunset gaze 6×4×2.5 cm intraventricular, irregular contours, microcalcifications, intense post-contrast enhancement, quadriventricular hydrocephalus 5 (CPC) 9 F Generalized tonic-clonic seizure; right hemiparesis, papilledema Heterogeneous, hyperdense, calcifications, hemorrhage, perilesional edema; heterogeneous enhancement, parenchymal invasion ( Figure 3 ) 6 (CPC) 3 M Headache, vomiting, seizures; clinically normal 11 cm solid lesion, heterogeneous enhancement, calcifications, marked mass effect 7 (CPC) 1.75 M Left-sided weakness, vomiting; left hemiparesis V3 origin, 8×6 cm hyperdense lesion, hemorrhagic foci, perilesional edema; heterogeneous signal, strong enhancement, biventricular hydrocephalus Radiological features Tumors were located in the lateral ventricles in five cases ( Figure 1 ), the third ventricle in one case, and the fourth ventricle with extension to the cerebellopontine angle (CPA) in one case ( Figure 2 ). CT imaging (performed in six patients) showed lobulated intraventricular masses that were iso- to hyperdense with homogeneous enhancement in CPPs, frequently associated with hydrocephalus. CPCs appeared heterogeneously hyperdense with intense enhancement and intratumoral calcifications in two of three cases. Figure 1. Brain MRI showing a papilloma that is hyperintense on T1 (a,b) and hypointense on T2 (c), associated with marked hydrocephalus. Figure 2. Brain MRI showing a choroid plexus papilloma of the fourth ventricle extending to the cerebellopontine angle, hypointense on T1 (a) and hyperintense on T2-weighted images (b). MRI (performed in five patients) demonstrated variable signal characteristics. CPPs were typically well-circumscribed and intensely enhancing, while CPCs appeared heterogeneous ( Figure 3 ), with areas of calcification, hemorrhage, and parenchymal invasion. Hydrocephalus was present in the majority of cases ( Table 1 ). Figure 3. T1-weighted images with gadolinium contrast in axial (a) and coronal (b) planes and T2 FLAIR axial (c) showing a choroid plexus carcinoma at the junction of the left lateral ventricle. Surgical management All patients underwent surgical intervention. Gross total resection was achieved in four patients, near-total resection in one, incomplete resection in one, and large biopsy in one. CPPs were generally friable and minimally hemorrhagic, whereas CPCs were highly vascular and hemorrhagic. Uncontrollable intraoperative bleeding occurred in one patient. Preoperative external ventricular drainage was required in two patients. Postoperatively, permanent cerebrospinal fluid diversion was necessary in two cases: one ventriculoperitoneal shunt following failed EVD weaning and one subdural-peritoneal shunt for postoperative subdural hygroma. Histopathological findings CPPs demonstrated typical papillary architecture with thin fibrovascular cores lined by monomorphic cuboidal epithelial cells, low cellularity, absence of necrosis, and no mitotic activity. CPCs exhibited high cellularity, nuclear pleomorphism, solid growth areas, frequent mitoses, and necrosis in two cases. Immunohistochemistry confirmed epithelial differentiation in all CPCs, with a Ki-67 index up to 40% in one case ( Figure 4 and Table 2 ). Figure 4. Examination of a choroid plexus carcinoma showing a largely necrotic tumor proliferation with high cellular density composed of papillary structures (a: H&E ×100) lined by highly atypical cells with numerous mitoses (arrow) (c: H&E, ×400). Tumors were positive for Cytokeratin 7 (b). Table 2. Histopathological characteristics. Obs Histology Key features Immunohistochemistry (IHC) 1 (CPP) Papillary Low cellularity, monomorphic, no necrosis, mitotic index 0 Keratin +, Vimentin +, PS100 +, Thyroglobulin -, GFAP low, Ki67 <1% 2 (CPP) Papillary Low-moderate cellularity, monomorphic, no necrosis, mitotic index 0 Keratin +, Vimentin +, GFAP +, Ki67 <1% 3 (CPP) Papillary Low cellularity, monomorphic, no necrosis, mitotic index 0 Not performed 4 (CPP) Papillary Low-moderate cellularity, monomorphic, no necrosis, mitotic index 0 Not performed 5 (CPC) Papillary, focal solid area High cellularity, diffuse pleomorphism, necrosis present, high mitotic index Cytokeratin 7 + 6 (CPC) Papillary & pseudo-acinar, solid High cellularity, diffuse pleomorphism, necrosis present, high mitotic index IHC inconclusive 7 (CPC) Papillary & solid High cellularity, focal pleomorphism, no necrosis, high mitotic index Pancytokeratin +, EMA -, GFAP -, PS100 -, Ki67 40% Outcomes All patients with CPP had a favorable postoperative course, with no tumor recurrence during follow-up ranging from 3 to 13 years. Two CPP patients required shunting for postoperative hydrocephalus or subdural hygroma. Among CPC patients, outcomes were poor. One patient died intraoperatively from hemorrhagic shock, another died on postoperative day 4 from myocardial infarction, and the third developed postoperative meningitis with residual hemiparesis and died shortly thereafter before initiation of chemotherapy ( Table 3 ). Table 3. Summary of patient management and outcomes. Obs Extent of resection Postoperative complications Adjuvant treatment Follow-up and outcome 1 Complete None None 13y Asymptomatic 2 Complete Subdural hygroma → ventriculoperitoneal shunt None 13y Asymptomatic 3 Complete None None 3y Asymptomatic 4 Complete Persistent hydrocephalus → subdural-peritoneal shunt None 13 Asymptomatic 5 Near-complete Myocardial infarction None Died on postoperative day 4 6 Incomplete Hemorrhagic shock None Hemorrhagic shock, Intraoperative death 7 Large biopsy Meningitis ➔ 21 days of antibiotics Chemotherapy not received 1 month, died before recieving chemotherapy Discussion Choroid plexus tumors (CPTs) are rare intraventricular neoplasms, predominantly affecting the pediatric population, particularly during the first years of life. 1 , 3 In our series, the median age at diagnosis was 2 years, with six of seven patients being children, reflecting the well-documented pediatric predominance of these tumors. The sex ratio was 2:5, indicating a slight female predominance, contrasting with some reports of equal distribution or slight male predominance. 8 Tumor characteristics varied by sex, location, and histology: cerebellopontine angle tumors were associated with older age, benign histology, and female sex, 4 , 10 consistent with our oldest patient (28 y, CPP, 4th ventricle extending to CPA). In contrast, infantile CPTs were mostly lateral ventricular and more common in males. 1 Clinical presentation was dominated by symptoms of increased intracranial pressure, mainly vomiting and headache, reflecting the high prevalence of hydrocephalus in CPTs. The median diagnostic delay was short (7 days), likely related to the rapid onset of symptoms in pediatric patients, particularly infants, in whom hydrocephalus manifests early with macrocephaly, lethargy, or irritability. This contrasts with adult patients, in whom intraventricular tumors may remain asymptomatic for longer periods. 9 , 11 , 12 Radiologically, our findings were concordant with the literature. CPPs typically appeared as well-circumscribed intraventricular masses with homogeneous enhancement, whereas CPCs demonstrated heterogeneous enhancement, calcifications, and parenchymal invasion causing vasogenic edema. 12 , 13 Diffusion-weighted imaging shows hypercellularity with restricted diffusion, and spectroscopy may help distinguish CPPs (myo-inositol peak) from CPCs (choline elevation). 11 , 14 Despite these suggestive features, differentiation between CPP and CPC based solely on imaging remained difficult, reinforcing the central role of histopathological examination for definitive diagnosis. Surgical management remains the cornerstone of treatment. 8 , 15 Gross total resection was achieved in the majority of CPP cases and was associated with excellent long-term outcomes, with no recurrences observed during follow-up. Management of CPCs remains challenging: complete excision is the goal but often difficult due to hypervascularity and invasive behavior. Infants and young children are particularly vulnerable to blood loss; excessive intraoperative bleeding can result in perioperative mortality, 16 as observed in one of our patients. Collaboration with anesthesiology teams experienced in pediatric neuro-oncology is essential. Preoperative embolization has been proposed to reduce bleeding but is technically challenging due to small, tortuous feeding vessels 17 ; MR angiography can assist in delineating the surgical corridor. CSF diversion is also a critical component of management. 18 Hydrocephalus, common in CPTs, may rapidly impair consciousness and sometimes requires urgent external ventricular drainage (EVD). Hydrocephalus often resolves after tumor resection, allowing EVD removal, but persistent obstruction due to necrotic debris, hemorrhage, or arachnoiditis may necessitate ventriculoperitoneal shunting. 4 , 8 Thus careful monitoring of ventricular size and intracranial pressure is mandatory. Postoperative subdural hygroma, a recognized complication after transcortical approaches in children, was also observed and successfully managed with cerebrospinal fluid diversion. 18 Histopathological examination remains the gold standard for the definitive diagnosis and grading of choroid plexus tumors. In our series, histological features were fully consistent with the 2021 WHO Classification of Tumors of the Central Nervous System (5th edition). CPPs displayed classic papillary architecture with low cellularity, absent atypia, and negligible mitotic activity, consistent with indolent, low-grade behavior, whereas CPCs exhibited high cellularity, nuclear pleomorphism, necrosis, and elevated Ki-67 (up to 40%), reflecting aggressive malignancy in line with WHO criteria. The diagnosis of CPC requires the presence of at least four of five histological features—high cellularity, nuclear pleomorphism, loss of papillary architecture, necrosis, and increased mitotic activity—which were met in our CPC cases. 6 , 7 , 19 Immunohistochemistry confirmed the epithelial origin of CPCs, which showed high Ki-67 proliferation indices (up to 40%) reflecting aggressive behavior, whereas CPPs exhibited very low Ki-67 (<1%), consistent with indolent biology. 12 , 19 At the molecular level, alterations of the TP53 pathway play a central role in choroid plexus tumorigenesis, particularly in choroid plexus carcinomas, where TP53 mutations are reported in up to 50% of cases. 20 , 21 Germline TP53 mutations, as seen in Li–Fraumeni syndrome, are strongly associated with pediatric CPC and carry important prognostic and therapeutic implications. 5 , 12 , 22 For CPCs, chemotherapy after incomplete resection can reduce tumor size and vascularity. From a therapeutic perspective, adjuvant chemotherapy and radiotherapy have been shown to improve survival in CPC patients, particularly following incomplete resection. 16 , 23 However, the use of radiotherapy in infants is limited by its long-term neurocognitive and endocrine toxicity. 24 In our series, adjuvant treatment could not be administered due to early postoperative mortality or rapid clinical deterioration, which likely contributed to the poor outcomes observed in CPC patients. Successful management of pediatric CPTs requires a multidisciplinary approach, meticulous preoperative planning, microsurgical expertise, proactive CSF management, and close postoperative surveillance. Tailoring the surgical strategy to tumor type, patient age, and vascular characteristics significantly reduces perioperative morbidity and improves long-term outcomes. Conclusion Overall, our findings reinforce the heterogeneity of CPTs. Complete surgical resection remains the key determinant of outcome in CPTs, while CPCs continue to carry a poor prognosis, highlighting the need for improved perioperative strategies and molecular-guided therapies. Strengths and limitations The main limitation of this study is the small sample size inherent to the rarity of CPTs, as well as its retrospective nature. Molecular analyses, particularly TP53 status, were not available, limiting biological stratification. Nevertheless, this series provides a detailed clinico-radiological and pathological correlation with long-term follow-up, illustrating real-life surgical challenges and outcomes. Ethics approval and consent to participate This retrospective descriptive study was conducted in accordance with the principles of the Declaration of Helsinki. Authorization to access patient medical records was obtained from the administration of Habib Bourguiba University Hospital. The study involved the analysis of anonymized data collected as part of routine clinical care, with no additional diagnostic or therapeutic procedures. No patient-identifying information was included. Given the retrospective, non-interventional nature of the study, formal approval from a local Institutional Review Board or Ethics Committee was not required, and the requirement for informed consent was waived in accordance with institutional policies. Data availability All patient-level data supporting the findings of this study are publicly available in Zenodo: Pediatric choroid plexus tumors: patient-level dataset: https://zenodo.org/records/18173300 , 25 DOI: 10.5281/zenodo.18173300 Pediatric choroid plexus tumors: dataset (English version): https://zenodo.org/records/18200748 , 26 DOI: 10.5281/zenodo.18200748 for the english version. This dataset includes all clinical, radiological, histopathological, immunohistochemical, treatment, and outcome variables for each patient included in the study. Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. Wolff JEA, Sajedi M, Brant R, et al. : Choroid plexus tumours. Br. J. Cancer. Nov. 2002; 87 (10): 1086–1091. PubMed Abstract | Publisher Full Text | Free Full Text 2. Wolburg H, Paulus W: Choroid plexus: biology and pathology. Acta Neuropathol. Jan. 2010; 119 (1): 75–88. Publisher Full Text 3. Bahar M, et al. : Choroid plexus tumors in adult and pediatric populations: the Cleveland Clinic and University Hospitals experience. J. Neuro-Oncol. May 2017; 132 (3): 427–432. PubMed Abstract | Publisher Full Text 4. Due-Tønnessen B, Helseth E, Skullerud K, et al. : Choroid plexus tumors in children and young adults: report of 16 consecutive cases. Childs Nerv. Syst. May 2001; 17 (4–5): 252–256. PubMed Abstract | Publisher Full Text 5. Abbes K, Khabir A, Bahloul K, et al. : Carcinome du plexus choroïde: à propos d’un cas. Neurochirurgie. Jun. 2009; 55 (3): 333–336. PubMed Abstract | Publisher Full Text 6. Louis DN, et al. : The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro-Oncology. Aug. 2021; 23 (8): 1231–1251. PubMed Abstract | Publisher Full Text | Free Full Text 7. Jaiswal S, et al. : Choroid plexus tumors: A clinico-pathological and neuro-radiological study of 23 cases. Asian J. Neurosurg. Mar. 2013; 8 (01): 29–35. PubMed Abstract | Publisher Full Text | Free Full Text 8. McEvoy AW, et al. : Management of Choroid Plexus Tumours in Children: 20 Years Experience at a Single Neurosurgical Centre. Pediatr. Neurosurg. 2000; 32 (4): 192–199. PubMed Abstract | Publisher Full Text 9. Naeini RM, Yoo JH, Hunter JV: Spectrum of Choroid Plexus Lesions in Children. Am. J. Roentgenol. Jan. 2009; 192 (1): 32–40. PubMed Abstract | Publisher Full Text 10. Kabashi A, Ahmetgjekaj I: Choroid Plexus Papilloma - Case Presentation. Curr. Health Sci. J. 2021; 47 (2): 310–313. PubMed Abstract | Publisher Full Text | Free Full Text 11. Akade E, Aslani F, Verdi K, et al. : Diagnosis of choroid plexus papilloma: Current perspectives and future directions. Cancer Pathogenesis and Therapy. Sep. 2023; 2 : 173–179. PubMed Abstract | Publisher Full Text | Free Full Text 12. Mohamed AA, Caussat T, Kelly S, et al. : Choroid plexus tumors: A spectrum from benign to malignant. TD. Aug. 2023; 2 (2): 1057. Publisher Full Text 13. Dash C, et al. : Management of Choroid Plexus Tumors in Infants and Young Children Up to 4 Years of Age: An Institutional Experience. World Neurosurg. Jan. 2019; 121 : e237–e245. PubMed Abstract | Publisher Full Text 14. Ozdogann S, et al. : Choroid plexus carcinoma in adults: an extremely rare case. Pan Afr. Med. J. 2015; 20 . PubMed Abstract | Publisher Full Text | Free Full Text 15. Bettegowda C, et al. : Treatment of choroid plexus tumors: a 20-year single institutional experience: Clinical article. PED. Nov. 2012; 10 (5): 398–405. PubMed Abstract | Publisher Full Text | Free Full Text 16. Koh EJ, et al. : Clinical outcome of pediatric choroid plexus tumors: retrospective analysis from a single institute. Childs Nerv. Syst. Feb. 2014; 30 (2): 217–225. PubMed Abstract | Publisher Full Text 17. Haliasos N, Brew S, Robertson F, et al. : Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery? Childs Nerv. Syst. Jan. 2013; 29 (1): 65–70. PubMed Abstract | Publisher Full Text 18. Hosmann A, et al. : Management of choroid plexus tumors—an institutional experience. Acta Neurochir. Apr. 2019; 161 (4): 745–754. PubMed Abstract | Publisher Full Text | Free Full Text 19. Crea A, et al. : Choroid Plexus Carcinoma in Adults: Literature Review and First Report of a Location into the Third Ventricle. World Neurosurg. Jan. 2020; 133 : 302–307. PubMed Abstract | Publisher Full Text 20. Tabori U, et al. : TP53 Alterations Determine Clinical Subgroups and Survival of Patients With Choroid Plexus Tumors. JCO. Apr. 2010; 28 (12): 1995–2001. PubMed Abstract | Publisher Full Text 21. Merino DM, et al. : Molecular Characterization of Choroid Plexus Tumors Reveals Novel Clinically Relevant Subgroups. Clin. Cancer Res. Jan. 2015; 21 (1): 184–192. PubMed Abstract | Publisher Full Text 22. Sourty B, Rousseau A: Prédisposition héréditaire aux tumeurs des systèmes nerveux central et périphérique. Ann. Pathol. Apr. 2020; 40 (2): 168–179. PubMed Abstract | Publisher Full Text 23. Tavallaii A, Keykhosravi E, Rezaee H, et al. : Role of available adjuvant therapies following surgical resection of atypical choroid plexus papilloma—a systematic review and pooled analysis. Neuro-Oncology Advances. Jan. 2020; 2 (1): vdaa139. PubMed Abstract | Publisher Full Text | Free Full Text 24. Mazloom A, Wolff JE, Paulino AC: The Impact of Radiotherapy Fields in the Treatment of Patients With Choroid Plexus Carcinoma. International Journal of Radiation Oncology*Biology*Physics. Sep. 2010; 78 (1): 79–84. PubMed Abstract | Publisher Full Text 25. Bounemra M: Pediatric Choroid Plexus Tumors: Patient-level. Dataset. Zenodo. 2026 7 Jan. Publisher Full Text 26. Bounemra M: Pediatric Choroid Plexus Tumors: Dataset (English Version). Zenodo. Jan. 2026; 9 . Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Feb 2026 ADD YOUR COMMENT Comment Author details Author details 1 Department of Neurosurgery, Habib Bourguiba Hospital, Sfax, Sfax, 3029, Tunisia 2 Department of Pathology, Habib Bourguiba Hospital, Sfax, Sfax, 3029, Tunisia Maïla Bounemra Roles: Conceptualization, Formal Analysis, Writing – Original Draft Preparation Fatma Kolsi Roles: Conceptualization, Project Administration, Supervision, Writing – Review & Editing Saadia Makni Roles: Investigation, Supervision, Validation Imen Dammak Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Mohamed Zaher Boudawara Roles: Supervision Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 09 Feb 2026, 15:212 https://doi.org/10.12688/f1000research.176833.1 Copyright © 2026 Bounemra M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Bounemra M, Kolsi F, Makni S et al. Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :212 ( https://doi.org/10.12688/f1000research.176833.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Feb 2026 Views 0 Cite How to cite this report: Omon H. Reviewer Report For: Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :212 ( https://doi.org/10.5256/f1000research.194944.r462231 ) The direct URL for this report is: https://f1000research.com/articles/15-212/v1#referee-response-462231 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Mar 2026 Henry Omon , Neurosurgery Division, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria; Spinal Injuires, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (Ringgold ID: 9885), Oswestry, England, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.194944.r462231 The topic is clinically relevant because CPTs are rare tumors and institutional experiences contribute to the understanding of their management. The manuscript provides descriptive clinical data and emphasizes the importance of gross total resection in choroid plexus papillomas and the ... Continue reading READ ALL The topic is clinically relevant because CPTs are rare tumors and institutional experiences contribute to the understanding of their management. The manuscript provides descriptive clinical data and emphasizes the importance of gross total resection in choroid plexus papillomas and the poorer outcomes associated with choroid plexus carcinoma. However, the manuscript has significant methodological and reporting limitations. 1 . Sample size Seven patients over 13 years is an extremely small cohort, even for a rare tumor. While this is acknowledged in the limitations, the authors do not adequately justify why this institutional experience adds meaningful value beyond what is already established in larger series. The paper would benefit from a more explicit statement of what is novel or unique about the Tunisian/North African context. For instance, resource constraints affecting access to molecular diagnostics or adjuvant therapy would make the contribution more compelling. 2. Statistical justification: The statistical analysis is limited to medians and frequencies, which is appropriate given the sample size, but this should be stated explicitly as a deliberate methodological choice. Phrases such as "the majority of cases" are used throughout the text but are imprecise when n=7; exact numbers should always be used instead. 3 . Incomplete and inconsistent immunohistochemistry IHC was not performed in two of four CPP cases (Obs 3 and 4), and was inconclusive in one CPC case (Obs 6). While resource constraints are understandable in the clinical context, this inconsistency weakens the histopathological characterisation that is presented as a strength of the paper. The authors should: Explain why IHC was not performed or was inconclusive in these cases. Clarify how the diagnosis of CPC was confirmed in Obs 6 without conclusive IHC, given that the differential diagnosis of CPC requires demonstration of epithelial markers. Discuss whether the absence of TP53 immunostaining (a widely available surrogate for TP53 mutation) was a missed opportunity, particularly in the CPC cases. 4 . Table 3 topographical error : Obs 4 follow-up is listed as "13" without a unit (presumably years, to match Obs 1 and 2). 5 . Discussion structure and focus The discussion is generally well-written but in places reads more like a literature review than a reflection on the authors' own findings. For example, the paragraphs on DWI/MRS imaging techniques, molecular biology (TP53, Li–Fraumeni syndrome), and preoperative embolisation are largely not tied back to specific cases in the series. The authors should either connect these observations to their own data or trim them to keep the discussion tethered to the institutional experience being reported. 6 . Surgical approach not described The methods section states that surgical approach was recorded as a variable, yet the results and Table 3 make no mention of the specific approaches used (e.g., transcortical, transcallosal, suboccipital). For a surgical series, this is a significant omission. Approach selection influences morbidity and outcomes and should be reported. 7 . Language and minor errors "extented" (page 4, Table 1, Obs 3) should be "extended." "recieving" (Table 3, Obs 7) should be "receiving." The sex ratio is described as "2:5" in the discussion — it would be clearer to write "male-to-female ratio of 2:5" or simply report the numbers. Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neurosurgery, Spine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Omon H. Reviewer Report For: Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :212 ( https://doi.org/10.5256/f1000research.194944.r462231 ) The direct URL for this report is: https://f1000research.com/articles/15-212/v1#referee-response-462231 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Feb 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 09 Feb 26 read Henry Omon , Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria; Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (Ringgold ID: 9885), Oswestry, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Omon H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Mar 2026 | for Version 1 Henry Omon , Neurosurgery Division, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria; Spinal Injuires, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (Ringgold ID: 9885), Oswestry, England, UK 0 Views copyright © 2026 Omon H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The topic is clinically relevant because CPTs are rare tumors and institutional experiences contribute to the understanding of their management. The manuscript provides descriptive clinical data and emphasizes the importance of gross total resection in choroid plexus papillomas and the poorer outcomes associated with choroid plexus carcinoma. However, the manuscript has significant methodological and reporting limitations. 1 . Sample size Seven patients over 13 years is an extremely small cohort, even for a rare tumor. While this is acknowledged in the limitations, the authors do not adequately justify why this institutional experience adds meaningful value beyond what is already established in larger series. The paper would benefit from a more explicit statement of what is novel or unique about the Tunisian/North African context. For instance, resource constraints affecting access to molecular diagnostics or adjuvant therapy would make the contribution more compelling. 2. Statistical justification: The statistical analysis is limited to medians and frequencies, which is appropriate given the sample size, but this should be stated explicitly as a deliberate methodological choice. Phrases such as "the majority of cases" are used throughout the text but are imprecise when n=7; exact numbers should always be used instead. 3 . Incomplete and inconsistent immunohistochemistry IHC was not performed in two of four CPP cases (Obs 3 and 4), and was inconclusive in one CPC case (Obs 6). While resource constraints are understandable in the clinical context, this inconsistency weakens the histopathological characterisation that is presented as a strength of the paper. The authors should: Explain why IHC was not performed or was inconclusive in these cases. Clarify how the diagnosis of CPC was confirmed in Obs 6 without conclusive IHC, given that the differential diagnosis of CPC requires demonstration of epithelial markers. Discuss whether the absence of TP53 immunostaining (a widely available surrogate for TP53 mutation) was a missed opportunity, particularly in the CPC cases. 4 . Table 3 topographical error : Obs 4 follow-up is listed as "13" without a unit (presumably years, to match Obs 1 and 2). 5 . Discussion structure and focus The discussion is generally well-written but in places reads more like a literature review than a reflection on the authors' own findings. For example, the paragraphs on DWI/MRS imaging techniques, molecular biology (TP53, Li–Fraumeni syndrome), and preoperative embolisation are largely not tied back to specific cases in the series. The authors should either connect these observations to their own data or trim them to keep the discussion tethered to the institutional experience being reported. 6 . Surgical approach not described The methods section states that surgical approach was recorded as a variable, yet the results and Table 3 make no mention of the specific approaches used (e.g., transcortical, transcallosal, suboccipital). For a surgical series, this is a significant omission. Approach selection influences morbidity and outcomes and should be reported. 7 . Language and minor errors "extented" (page 4, Table 1, Obs 3) should be "extended." "recieving" (Table 3, Obs 7) should be "receiving." The sex ratio is described as "2:5" in the discussion — it would be clearer to write "male-to-female ratio of 2:5" or simply report the numbers. Is the background of the cases’ history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the conclusion balanced and justified on the basis of the findings? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Neurosurgery, Spine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Omon H. Peer Review Report For: Choroid Plexus Tumors: Insights from a 13-Year Single-Institution Series [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :212 ( https://doi.org/10.5256/f1000research.194944.r462231) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-212/v1#referee-response-462231 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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