Department of Neurosurgery, University Medicine Greifswald, Germany;
Department of Neurosurgery, Kasr Alainy Research and Teaching Hospital, Cairo University, Egypt;
J Neurosurg. 2016 Sep;125(3):576-84. doi: 10.3171/2015.7.JNS151005. Epub 2016 Jan 8.
OBJECTIVE Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. Endoscopic stent placement for treatment of CSF pathway obstruction is a rarely used and 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. METHODS The authors retrospectively reviewed a prospectively maintained clinical database for endoscopic stent placement performed in adults between 1993 and 2013. 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.
自 20 世纪 90 年代初复苏以来，神经内镜已成为现代神经外科不可或缺的组成部分。内镜支架置入术治疗脑脊液（CSF）通路梗阻是一种很少使用且被低估的方法。作者报告了首例成人 CSF 通路梗阻的神经内镜颅内支架置入术系列病例，并报道了长达 20 年的长期随访结果和并发症。
作者回顾性分析了 1993 年至 2013 年期间在成人中进行的内镜下支架置入术的前瞻性维护临床数据库。
在 526 例内镜脑室内操作中，有 25 例（4.8%）因 CSF 疾病而行支架置入术。该技术用于蛛网膜囊肿（AC）的治疗（n = 8）、肿瘤相关 CSF 疾病的治疗（n = 13）、Monro 孔（n = 2）或中脑导水管（n = 2）狭窄性脑积水的治疗。平均随访时间为 87.1 个月。无与内镜颅内支架置入相关的死亡或感染发生。3 例患者（12%）出现迟发性支架移位或迁移。
成人神经内镜颅内支架置入术很少需要，但在某些情况下是一种安全且有益的技术。当标准内镜技术不能可靠且持久地恢复 CSF 通路梗阻时，需要进行该手术。在肿瘤相关性脑积水的治疗中，它是避免肿瘤生长导致重建的 CSF 通路再关闭的一个很好的选择。目前，不推荐常规在 AC 内镜开窗术后行支架置入术。对于肿瘤引起的 CSF 疾病的治疗，支架置入术是避免 CSF 分流的一种很好的选择。为了避免支架迁移和脱位，并在需要时便于取出，应将该装置固定到颅骨钻孔储液器上。
