gms | German Medical Science

Objective: Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. Endoscopic stent placement for treatment of cerebrospinal fluid (CSF) pathway obstruction is a rarely used and an underestimated procedure. The authors present the first series of neuroendoscopic intracranial stenting for CSF pathway obstruction in adults with associated results and complications spanning a long-term follow-up of 20 years.

Method: The authors retrospectively reviewed a prospectively maintained database for endoscopic stent placement in adults between the years of 1993 and 2013.

Results: Out of 526 endoscopic intraventricular procedures, stents were placed for treatment of CSF disorders in 25 (4.8%) cases. The technique was used in the management of arachnoid cysts (AC) (n=8), tumor-related CSF disorders (n=13), and hydrocephalus due to stenosis of the foramen of Monroe (n=2) or aqueduct (n=2). The mean follow-up was 87.1 months. There was no operative mortality nor infection related to endoscopic placement of intracranial stents. Late stent dislocation or migration was observed in three patients (12%).

Conclusions: Endoscopic intracranial stent placement in adults is rarely required, but is a safe and helpful technique in selected cases. Currently, routine stent placement after endoscopic fenestration of arachnoid cysts is not recommended. Stent placement for treatment of CSF disorders due to tumor is a good option to avoid CSF shunting. To avoid stent migration and dislocation as well as to allow an easy removal of the stent in the case of infection or malfunction, the device should be fixed to a burr hole reservoir.