Risks of Endoscopic Temporal Ventriculocisternostomy for Isolated Lateral Ventricle: Anatomic Surgical Nuances

Entrapment of the temporal horn, known as isolated lateral ventricle (ILV), is a rare type of noncommunicating focal hydrocephalus, and standard treatment has not been established. We report 2 cases of endoscopic surgery for ILV and highlight the anatomic surgical nuances to avoid associated surgical risks.

The first patient presented with recurrent ILV following initial shunt placement for ILV, owing to shunt malfunction. In the second patient, ILV recurred secondary to choroid plexus inflammation caused by cryptococcal infection. Endoscopic temporal ventriculocisternostomy was effective in both cases. However, in the second case, the choroidal fissure was fenestrated, which led to cerebral infarction in the territory of the choroidal artery zone, attributed to damage of the branches of the choroidal segment of the anterior choroidal artery.

Although endoscopic temporal ventriculocisternostomy is considered a safe and less invasive procedure for treatment of symptomatic ILV, the technique is still associated with risks. To avoid complications, it is necessary to be familiar with the anatomy of the choroidal arteries and the pertinent endoscopic intraventricular orientation. Additionally, sufficient experience is required before it can be recommended as the treatment of choice.