Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Neurology

Background:

• Neuroendoscopy has become a cornerstone of modern neurosurgery since the 1990s.
• Endoscopic stent placement for cerebrospinal fluid (CSF) pathway obstruction is an underutilized yet valuable technique.
• This study presents the first long-term series of neuroendoscopic intracranial stenting in adults.

Observation:

• The authors reviewed 526 endoscopic intraventricular procedures, identifying 25 cases (4.8%) where stents were placed for CSF disorders between 1993 and 2013.
• Indications included arachnoid cysts (n=8), tumor-related CSF disorders (n=13), and stenosis of the foramen of Monro or aqueduct (n=4).
• The mean follow-up was 87.1 months, with no procedure-related deaths or infections.

Findings:

• Late stent dislocation or migration occurred in 3 patients (12%).
• No deaths or infections were associated with the endoscopic stent placement.
• The technique demonstrated safety and efficacy in select adult cases.

Implications:

• Endoscopic intracranial stent placement is a safe and helpful technique for specific CSF pathway obstructions when standard endoscopic methods fail.
• It is a viable option for tumor-related hydrocephalus to prevent pathway reclosure by tumor growth and avoid CSF shunting.
• Routine stenting after fenestration of arachnoid cysts is not recommended; fixation to a burr hole reservoir is advised to prevent migration and facilitate removal.