Management of Entrapped Temporal Horn by Temporal Horn to Prepontine Cistern Shunting

BACKGROUND: Entrapped temporal horn syndrome secondary to obstructive neoplastic lesions is most frequently treated by surgical excision of the offending lesion. Here we describe an alternate approach involving temporal horn to prepontine cistern shunting followed by radiosurgery of the offending lesion. METHODS: A 41-year-old woman with a history of meningiomatosis presented with progressive, incapacitating headache. Magnetic resonance imaging (MRI) showed growth of a right trigone meningioma, causing entrapment of the right temporal horn. A ventricular catheter was placed using frame-based stereotaxy and image fusion computed tomography/MRI to connect the entrapped lateral ventricle to the prepontine cistern. The patient reported complete resolution of her symptoms after the procedure. RESULTS: Postoperative MRI revealed decompression of the temporal horn. The trigonal meningioma was treated with stereotactic radiosurgery. The patient remained asymptomatic at the 2-year follow-up. CONCLUSIONS: Trapped temporal horn syndrome secondary to obstructive neoplastic lesions can be treated by internal shunting followed by radiosurgery.