Ventriculoscopic outcomes from 249 consecutive patients: the role of a left sided approach

Left-sided neurosurgery has been associated with higher neurocognitive complications owing to the cytoarchitectural localization of higher-order cognitive functions (e.g. language) in the left hemisphere. Left-sided ventriculoscopy, given its smaller distortion of brain parenchyma, is believed to minimize brain injury and lead to comparatively insignificant side effects compared to right sided approaches. Large longitudinal studies are however needed to confirm this hypothesis. In this study, we performed a retrospective review of 249 ventriculoscopic procedures performed in a tertiary care center over twelve years and compared clinical, surgical, and outcomes parameters between patients who had a right-sided endoscopy and those who had a left-sided approach. We further present a case series highlighting the reasons for a left-sided surgical approach was used. 68 procedures (27.3%) were carried out through a left-sided approach and 181 via the right side (72.7%). Left- and right-side cohorts were similar with respect to patient characteristics, albeit they differed in exact pathology. The surgical outcome was achieved in all patients who underwent a left-sided surgery and in all but two patients who underwent a right-sided procedure ( p = 0.99). The two cohorts did not differ with respect to rate of surgical complications ( p = 0.99), below 5%, or functional outcome reflecting real-word reintegration ( p = 0.99). When endoscopic third ventriculostomies (ETVs) were assessed, no difference was found between left- and right-sided procedures, with success rates similar to those predicted by the ETV success score. Left-sided ventriculoscopy represents a valid and safe procedure in carefully selected patients in whom anatomical consideration favor ventricular access through the dominant hemisphere.