Clinical characteristics of and treatment protocol for trapped temporal horn following resection of lateral ventricular trigone meningioma: a single-center experience

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OBJECTIVE

Trapped temporal horn (TTH) is a rare subtype of loculated hydrocephalus that is often managed surgically. The natural history of TTH is not well understood, and there are few data on the outcomes of conservative management of this condition. The aim of this study was to analyze the clinical features and outcomes of conservatively and surgically managed cases of TTH.

METHODS

The authors retrospectively reviewed the clinical data for 19 consecutive cases of TTH that developed after microsurgical resection of lateral ventricular trigone meningioma between 2011 and 2015.

RESULTS

The 19 cases involved 6 male and 13 female patients (mean age [± SD] 39.9 ± 13.8 years). The mean time interval from tumor resection to onset of TTH was 3.2 ± 3.0 months (range 3 days–10 months). Symptoms of intracranial hypertension were the most common complaints at presentation. The mean Karnofsky Performance Scale (KPS) score at onset was 52.1 ± 33.3 (range 10–90). Midline shift was observed in 15 cases (78.9%), and the mean amount of midline shift was 6.0 ± 4.8 mm (range 0–15 mm). Eleven cases (57.9%) were managed with surgical intervention, while 8 cases (42.1%) were managed conservatively. All patients (100%) showed improved clinical status over the course of 4.8 ± 1.0 years (range 2.8–6.3 years) of follow-up. The mean KPS score at last follow-up was 87.9 ± 11.3 (range 60–100). Eighteen patients (94.7%) showed signs of radiographic improvement, and 1 patient (5.3%) exhibited stable size of the temporal horn. Significant differences were observed between the surgical and nonsurgical cohorts for the following variables: KPS score at onset, presence of intracranial hypertension, and midline shift. The mean KPS score at onset was greater (better) in the nonsurgical group than in the surgical group (82.5 ± 8.9 vs 30 ± 25.7, p = 0.001). A greater proportion of patients in the surgical group presented with symptoms of intracranial hypertension (81.8% vs 0%, p = 0.001). The extent of midline shift was greater in the surgical group than in the nonsurgical group (9.0 ± 3.8 mm vs 2.0 ± 2.4 mm, p = 0.001).

CONCLUSIONS

The majority of patients with TTH presented in a delayed fashion. TTH is not always a surgical entity. Spontaneous resolution of TTH may be under-reported. Conservative management with clinical and radiological follow-up is effective in selected patients.

ABBREVIATIONS CSF = cerebrospinal fluid; EVD = external ventricular drainage; KPS = Karnofsky Performance Scale; PVBE = periventricular brain edema; TTH = trapped temporal horn; VP = ventriculoperitoneal.

Article Information

Correspondence Zhongli Jiang: Beijing Tiantan Hospital, Capital Medical University, Beijing, China. jiangzhongli5@aliyun.com.

INCLUDE WHEN CITING Published online February 15, 2019; DOI: 10.3171/2018.11.JNS182710.

Z.L. and C.W. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart depicting the selection of patients for the study.

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    Case 2. A and B: CT (A) and axial T2-weighted MR (B) images showing dilation of the right temporal horn, PVBE, midline shift, and compression of the brainstem. C: Axial fluid-attenuated inversion recovery image showing a thin septation in the trigone of the right lateral ventricle. D and E: Axial T2-weighted MR images obtained 4 (D) and 10 (E) months after microsurgical fenestration showing a decrease in the size of the temporal horn.

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    Case 4. Axial T2-weighted MR images obtained 13 days (A), 1 month (B), and 2 years (C) after tumor resection. The image obtained 13 days after tumor resection shows a slightly enlarged temporal horn, and the image obtained 1 month postoperatively reveals obvious enlargement of the left temporal horn with prominent PVBE and marked midline shift. The follow-up image obtained 2 years later shows spontaneous reduction of the TTH and elimination of PVBE.

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    Case 12. A: Axial T2-weighted MR image demonstrating total resection of a left trigone meningioma. B: Axial T2-weighted MR image obtained 4 months postoperatively demonstrating features suggestive of a delayed TTH. C: Axial T2-weighted MR image obtained 4 months postoperatively showing good visualization of the cortical and ependymal defects. D: Axial T2-weighted MR image obtained 10 months postoperatively showing an increase of ventricle size but gradual resolution of PVBE. E: Follow-up CT image obtained 1 year postoperatively showing a decrease in the size of the temporal horn. F and G: Axial T2-weighted MR images obtained 2 years after craniotomy confirming stability of the temporal horn and the cortical and ependymal defects.

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    Case 13. A and B: CT images demonstrating a very large, dilated TTH. C: Postoperative CT image obtained after shunt placement demonstrating a well-decompressed temporal horn. D and E: CT images obtained 9 days following surgery demonstrating significant reduction in size of the dilated temporal horn.

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