Choroid plexus tumors (CPT), especially in pediatric patients, present a major surgical challenge due to their hypervascularity and frequent intraventricular location. Preoperative embolization has emerged as a strategy to minimize intraoperative blood loss and improve surgical outcomes, yet its application in large-volume tumors via the anterior choroidal artery (AChA) remains limited.

We report a case of a 10-month-old infant with a giant choroid plexus carcinoma (CPC) measuring 189 cm³, treated with superselective embolization through the AChA using Squid™ prior to surgical resection. A systematic review was also conducted, including 9 studies on preoperative embolization via AChA for CPTs, with attention to technique, tumor volume, agents used, and outcomes.

Microcatheterization beyond the plexal point of the AChA enabled safe delivery of the embolic agent, achieving substantial tumor devascularization without ischemic or hemorrhagic complications. Surgical resection was completed without intraoperative blood transfusion or neurological sequelae. The systematic review confirmed the rarity of embolization in tumors exceeding 100 cm³, highlighting our case as one of the largest successfully treated using this approach.

Superselective preoperative embolization of choroid plexus tumors via the anterior choroidal artery is technically feasible and safe when performed beyond the plexal point. In high-risk pediatric cases with large-volume tumors, this strategy can significantly improve surgical safety and should be considered as part of a multimodal treatment approach.