It depends I guess, I opted to have the whole system inside my case, but that's only because my case is large enough (Coolermaster HAF 932), otherwise most people have the radiator/fan assembly on the outside rear of the case. You can get adapters for your type of motherboard to mount the heat sink correctly, I can't remember if I got mine with the motherboard, processor, or water cooling itself, but I definitely got the adapter with one of those, so there's no need for a special mobo. Maintenance isn't really an issue, if you have to regularly top up the water/anti-freeze mixture then there's probably a problem somewhere..