Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Abstract

Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. 7,16,19 Various endoscopic techniques have been described and are frequently used for the treatment of CSF circulation disorders including third ventriculostomy, septostomy, lamina terminalis fenestration, temporal ventriculostomy, foraminoplasty of the foramen of Monro, and aqueductoplasty. 21 Endoscopic placement of indwelling stents, however, is a rarely performed, but nonetheless valuable, procedure. The best-studied stenting procedure is aqueductal stenting in the setting of triventricular hydrocephalus and in cases of isolated fourth ventricles in children, which is known to be technically feasible and has shown good results in long-term follow-up. 2,9,13,18,22 Limited reports exist, however, about the value and outcome of endoscopic stent placement in adults.We present the first series of neuroendoscopic stent placement in adults from a single center over 20 years. The aim of the present study was to identify favorable indications for neuroendoscopic stent placement in adults, including operative results, complications, and clinical outcomes data.abbreviatioNs AC = arachnoid cyst; ETV = endoscopic third ventriculostomy. results Of 526 endoscopic intraventricular procedures, stents were placed for treatment of CSF disorders in 25 cases (4.8%). The technique was used in the management of arachnoid cysts (ACs; n = 8), tumor-related CSF disorders (n = 13), and hydrocephalus due to stenosis of the foramen of Monro (n = 2) or aqueduct (n = 2). The mean follow-up was 87.1 months. No deaths or infections occurred that were related to endoscopic placement of intracranial stents. Late stent dislocation or migration was observed in 3 patients (12%). coNclusioNs Endoscopic intracranial stent placement in adults is rarely required but is a safe and helpful technique in select cases. It is indicated when reliable and long-lasting restoration of CSF pathway obstructions cannot be achieved with standard endoscopic techniques. In the treatment of tumor-related hydrocephalus, it is a good option to avoid reclosure of the restored CSF pathway by tumor growth. Currently, routine stent placement after endoscopic fenestration of ACs is not recommended. Stent placement for treatment of CSF disorders due to tumor is a good option for avoiding CSF shunting. To avoid stent migration and dislocation, and to allow for easy removal if needed, the device should be fixed to a bur hole reservoir.

Endoscopic Intraventricular Atrial Adhesiolysis for the Treatment of Entrapped Temporal Horn after İntraventricular Tumor Surgery

“…5 It can develop secondary to penetrating trauma, meningitis, ventriculitis, intraventricular abscess, intraventricular hemorrhage, and intraventricular arachnoid cysts. 2,3 CSF pathway obstruction due to adhesions after tumor resection, such as our case, is a rarely reported etiology. 1,4 Ventriculoperitoneal shunting is being the most common used method for the treatment of entrapped temporal horn.…”

“…2 Few reported cases described the treatment of entrapped temporal horn with endoscopic temporal ventriculocisternostomy. 1,3 Although there is no standard guideline for the treatment method for these situations, there is general acceptance that attempts should be directed to reconnect the CSF pathway whenever possible, either by restoration of the original path to the atrium or by creating a communication to the subarachnoid space with opening the choroidal fissure. 2 Although endoscopic temporal ventriculocisternostomy showed to be safe and effective technique with good results in the reported cases, some studies concluded that this technique is not risk free of complications.…”

“…1 Some studies reported the stent use to support the stoma and prevent reclosure. 3 Marx et al described neuroendoscopic stenting for CSF pathway obstructions in adults. 3 Patients had arachnoid cysts, foramen of Monro or aqueduct stenosis, and CSF obstruction secondary to tumors.…”

“…2 Other treatment options were described, such as resection of the temporal tip, temporal horn ventriculocisternostomy, temporal to frontal horn shunt, and temporal to prepontine cistern shunt. [1][2][3][4] In this study, we present a case with entrapped temporal horn developed after intraventricular tumor resection due to adhesions in the resection bed, and treated with successful short-and long-term results with endoscopic adhesiolysis.…”

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

“…The same technology can be effectively used for intraventricular stent procedures (aqueductoplasty and stenting), as well as intratumoral stenting (in craniopharyngiomas sealing off the prior ETV or in a posterior third ventricular region tumor occluding the aqueduct). 3,9, 21,29,33,49,66,69,83 Magnetic resonance compatibility can be helpful in treating intraventricular neurocysticercosis as well as juxtaventricular parenchymal cystic changes such as tumefactive enlargement of thalamopeduncular Virchow-Robin spaces. 3,24 …”