Intraoperative Direct Third Ventriculostomy and Aqueductal Stenting in Deep-Seated Midline Brain Tumor Surgery

Pitskhelauri, D I; Konovalov, Alexander N.; Kornienko, V N; Serova, N K; Arutiunov, N V; Kopachev, D N

doi:10.1227/01.neu.0000338260.05545.84

Cited by 12 publications

(11 citation statements)

References 46 publications

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“…17 Although the stent is a foreign body and should have a higher infection risk, in our series, no stent-related infections occurred, which is consistent with multiple other reports. 13,17,18 In contrast, Ersahin et al reported the need for stent removal due to ventriculitis in 1 patient. 5 Patient age appears to be a risk factor for stent-related infections.…”

Section: Stent Placement Is a Safe Procedures During Neuroendoscopysupporting

confidence: 92%

“…3,18 In the series of Pitskhelauri et al, 1 of 30 aqueductal stents dislocated into the cerebellar vermis without consequence. 17 In Cases 2 and 25 of our series, stent dislocation occurred and the patients underwent repeat surgery. In Case 24 of our series, slight downward migration of the stent was noted on 1-year follow-up imaging, but the stent position was stable over the following 19 years.…”

Section: Stent Placement Is a Safe Procedures During Neuroendoscopymentioning

confidence: 79%

“…Ersahin et al observed similar problems, 5 but no stent migration was reported in other series. 17,18 Rapid change in ventricle size has been reported as a possible association with an increased chance of stent dislodgement. 22 To avoid stent migration, we advise fixation of the stent to a bur hole reservoir (Fig.…”

Section: Stent Placement Is a Safe Procedures During Neuroendoscopymentioning

confidence: 99%

“…12,14,19,23 An additional advantage of stent placement in tumor patients is the reduction in shuntrelated complications, including the risk of intraperitoneal spread of tumor cells. 17 Hydrocephalus with aqueductal stenosis due to tumor involvement can be treated by ETV or aqueductal stenting in select patients. 6,8,9,14,19 In a series by Pitskhelauri et al in 84 patients, tumor resection and restoration of the CSF pathway was performed during 1 procedure.…”

Section: Stent Placement For Treatment Of Tumor-related Csf Disordersmentioning

confidence: 99%

“…However, Pitskhelauri performed the stent procedures with the microsurgical technique. 17 In a series of Berlis et al, tumor cysts were stented into the ventricle by using stereotactic planning and the endoscopic technique. 1 In the present study, all procedures to restore CSF flow or prevent tumor-induced CSF blockade demonstrated good clinical and radiological results despite the limited follow-up proscribed by the natural history of the primary diseases.…”

Section: Stent Placement For Treatment Of Tumor-related Csf Disordersmentioning

confidence: 99%

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Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Marx

Fleck

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et al. 2016

JNS

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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.

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Section: Stent Placement Is a Safe Procedures During Neuroendoscopysupporting

confidence: 92%

Section: Stent Placement Is a Safe Procedures During Neuroendoscopymentioning

confidence: 79%

Section: Stent Placement Is a Safe Procedures During Neuroendoscopymentioning

confidence: 99%

Section: Stent Placement For Treatment Of Tumor-related Csf Disordersmentioning

confidence: 99%

Section: Stent Placement For Treatment Of Tumor-related Csf Disordersmentioning

confidence: 99%

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Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Marx

Fleck

Refaee

et al. 2016

JNS

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Stented endoscopic third ventriculostomy—indications and results

2015

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Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study

et al. 2020

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Intraoperative Direct Third Ventriculostomy and Aqueductal Stenting in Deep-Seated Midline Brain Tumor Surgery

Abstract: Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

Cited by 12 publications

References 46 publications

Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Stented endoscopic third ventriculostomy—indications and results

Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study

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