Refined temporal-to-frontal horn shunting for trapped temporal horn syndrome: long-term outcomes and complication management in a two-center series of 53 patients

OBJECTIVE: Trapped temporal horn syndrome (TTH) is a rare form of obstructive hydrocephalus that frequently occurs after intraventricular tumor resection. Effective long-term management remains challenging. This study evaluated the long-term outcomes and complication management of refined temporal-to-frontal horn shunting (RTFHS) in patients with TTH. METHODS: This retrospective case series included 53 consecutive patients with imaging-confirmed TTH treated at Beijing Tiantan Hospital of Capital Medical University and Beijing Fengtai Hospital between January 2018 and January 2025. Patients presented with symptoms such as headache, cognitive decline, or motor deficits and had a history of brain tumor surgery. All underwent RTFHS, with follow-up durations ranging from 1 month to 6 years. Of the 53 patients, 28 had follow-up over 6 months and 18 over 1 year. All patients received RTFHS with ipsilateral, contralateral, or bilateral shunting approaches. Primary outcomes included symptom improvement and temporal horn volume reduction. Secondary outcomes included management of complications such as high-protein CSF, infection, or suspected shunt catheter intolerance. RESULTS: The initial shunt patency rate was 86.8%, and the overall success rate reached 98.1%. Mean temporal horn volume reduction was 30.0% on the day of surgery and 60.3% at 3 months. Locally weighted scatterplot smoothing (LOWESS) regression revealed a rapid decrease in the 1st week, a slower decline from 1 week to 3 months, and stabilization thereafter. Long-term follow-up showed no recurrence or re-enlargement in most patients. Complications were effectively managed in nearly all cases. CONCLUSIONS: RTFHS is a safe, adaptable, and effective surgical option for managing TTH. It offers favorable long-term outcomes and may be a valuable alternative to a ventriculoperitoneal shunt in selected patients. This study provides useful insights into the prevention and management of perioperative issues.