Introduction: Xanthogranulomas of the choroid plexus (CPXG) are benign tumors which are most often found incidentally at autopsy. They have been reported in 1.4-7.0% of all autopsies. They are more common in the elderly populations and are very rare in children. Here we report a 4 year old boy with unusual headaches, bilateral CPXG and complete symptom-resolution after MRI-guided laser ablation (MGLA).

Methods:
Case Report and Literature Review.

Case Description:
A 4 year-old, previously healthy boy presented to clinic with headaches progressing from a few times a week to 3-4 times daily over the course of several months. They were exacerbated by sleep and lying supine.  Lying with an elevated head decreased the severity but not the frequency of the headaches. They were intermittently associated with "blurred vision” but no photo/phonophobia or nausea. NSAIDS provided minimal pain relief. Neurological examination, including fundoscopy, was normal. Magnetic resonance imaging of the brain revealed bilateral CPXG. Lumbar puncture showed normal opening pressures and magnetic resonance venography was negative. The patient underwent stereotactic MGLA of the CPXG resulting in a decrease in the size of the CPXG and complete resolution of his headaches.

Conclusion/Discussion:

Xanthogranulomas of the choroid plexus may present with unusual headaches in childhood and require detailed assessments and investigations. Intermittent positional obstruction of CSF flow and changes in CSF secretion may not be reflected in CSF pressure measurements.  Clinical history is essential for guidance of therapy. MGLA proved to be a safe and effective treatment modality.