Surgical techniques for treatment and prevention of entrapped temporal horn after resection of trigone ventricular tumors

Abstract

Aim. To analyze the effectiveness of treatment and prevention of entrapped temporal horn (ETH) using various techniques.Materials and methods. The study included 14 patients who underwent treatment or surgical prevention of ETH of the lateral ventricle after surgical resection of tumors in the projection of the trigone of the lateral ventricle. In 3 cases, microsurgical ventriculocisternostomy was performed; in 3 cases, shunting surgeries for ETH treatment; in 8 cases, ETH stenting.Results. Tumor resection level, stenting effectiveness per presence/absence of hydrocephalus, and adequacy of the chosen ETH treatment and prevention methods were analyzed. In all 3 cases of ventriculocisternostomy, tumor resection was radical, stoma was strong, ETH opened, hydrocephalus was absent. In 3 patients with shunt implantation, radical resection was performed in 1 case; in 2 cases subtotal resection was achieved; shunt dysfunction due to tumor progression was observed in 1 patient during long‑term follow‑up. In 7 of 8 patients with cases of ventricular stent implantation for treatment/prevention of ETH, tumor resection was total; in 1 patient subtotal. Stenting performed in the postoperative period for treatment of hydrocephalus had positive clinical effect in 100 % of cases (non‑focal neurological symptoms, stasis in the fundus, speech disorders regressed). In stenting for hydrocephalus prevention, a positive effect was also observed (no increase in the size of the ventricular system, shunting surgeries in the postoperative period were not required). In the analyzed patient group (n = 14), de novo neurologic deficit did not develop, no cases of infectious complications and cerebrospinal fluid leak were observed, stent did not dysfunction.Conclusion. Intraoperative ventriculocisternostomy is a reliable physiological technique for ETH prevention. Stenting of the ventricular system is an accessible and effective technique for ETH prevention. Single‑step stenting after tumor resection allows to avoid this complication in the long‑term and is not associated with surgical complications of distal stenting. The use of stenting surgeries has its advantages and disadvantages which makes this method acceptable but not universal. Implantation of shunt in the long‑term period is the method of choice for ETH treatment.