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Kumarasamy S, Spennato P, Di Martino G, Russo C, Mirone G, Covelli E, Cinalli G. Giant tumefactive mesencephalothalamic Virchow-Robin space with triventricular hydrocephalus: a case-based systematic literature review. Childs Nerv Syst 2024:10.1007/s00381-024-06610-6. [PMID: 39269463 DOI: 10.1007/s00381-024-06610-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The perivascular spaces of the brain are also known as Virchow-Robin spaces (VRSs). Dilated Virchow-Robin spaces in the brainstem are rare and mainly cause symptoms due to obstructive hydrocephalus, less frequently because of their size, mass effect, and impact on eloquent structures. CASE ILLUSTRATION We present a patient with giant tumefactive VRS with hydrocephalus and neurological symptoms who was treated with endoscopic third ventriculostomy (ETV) followed by microscopic cyst fenestration. On the basis of this observation, we performed a thorough review of the literature to evaluate different treatment options. RESULTS An 11-year-old girl presented with a headache for 3 months. The patient had a giant tumefactive mesencephalothalamic VRS with triventricular hydrocephalus. She was initially treated with endoscopic third ventriculostomy and multiple cyst fenestration. Symptomatic cyst regrowth required multiple cyst fenestrations via transcallosal transchoroidal (N = 2) and subtemporal approaches (N = 1) at the 2- and 4-year follow-ups. A literature review of these conditions allowed the detection of 12 cases (including our index case), and only 25% (3/12) of the patients underwent cyst fenestration 16.7% (2/12) required endoscopic fenestration and 8.3% (1/12) required microscopic fenestration. CONCLUSION Giant mesencephalothalamic dVRSs are rare in the pediatric population. These patients are usually symptomatic due to obstructive hydrocephalus. Surgical options are endoscopic third ventriculostomy, ventricular shunt procedures, or direct cyst fenestration (microscopic or endoscopic). Close follow-up is mandatory owing to the risk of progression of the disease. Cyst fenestration resolves symptoms immediately, as it addresses both hydrocephalus and mass effects due to the cystic lesion in the same setting.
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Affiliation(s)
- Sivaraman Kumarasamy
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital (AORN) , Via Mario Fiore n. 6, 80129, Naples, Italy
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pietro Spennato
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital (AORN) , Via Mario Fiore n. 6, 80129, Naples, Italy
| | - Giuliana Di Martino
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital (AORN) , Via Mario Fiore n. 6, 80129, Naples, Italy
| | - Carmela Russo
- Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital (AORN), Via Mario Fiore n. 6, 80129, Naples, Italy
| | - Giuseppe Mirone
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital (AORN) , Via Mario Fiore n. 6, 80129, Naples, Italy
| | - Eugenio Covelli
- Department of Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital (AORN), Via Mario Fiore n. 6, 80129, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital (AORN) , Via Mario Fiore n. 6, 80129, Naples, Italy.
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Mizutani H, Misumi Y, Ueda M. Teaching NeuroImage: Giant Tumefactive Perivascular Spaces: Longitudinal Follow-Up. Neurology 2024; 103:e209643. [PMID: 38981084 DOI: 10.1212/wnl.0000000000209643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Affiliation(s)
- Hironori Mizutani
- From the Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Yohei Misumi
- From the Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Mitsuharu Ueda
- From the Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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Benson JC, Trejo-Lopez JA, Cormier JL, Parney IF, Mark IT, Madhavan AA, Kotsenas AL, Rydberg CH, Luetmer PH, Eckel LJ, Johnson DR. Radiology-pathology correlation: Giant tumefactive perivascular spaces. Neuroradiol J 2024:19714009241247459. [PMID: 38613202 DOI: 10.1177/19714009241247459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Dilated perivascular spaces (PVSs) are common and easily recognized on imaging. However, rarer giant tumefactive PVSs (GTPVSs) can have unusual multilocular cystic configurations, and are often confused for other pathologic entities, including neoplasms, cystic infarctions, and neuroepithelial cysts. Because GTPVSs are scarcely encountered and even more infrequently operated upon, many radiologists are unaware of the imaging and pathologic features of these lesions. Here, a case of a resected GTPVS is presented, highlighting both its radiologic and histologic characteristics, and discussing how such lesions can be differentiated from their closest mimickers on imaging.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason L Cormier
- Department of Neurosurgery, Acadiana Neurosurgery, Lafayette, LA, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, LA, USA
| | - Ian T Mark
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Parillo M, Vaccarino F, Di Gennaro G, Kumar S, Van Goethem J, Beomonte Zobel B, Quattrocchi CC, Parizel PM, Mallio CA. Overview of the Current Knowledge and Conventional MRI Characteristics of Peri- and Para-Vascular Spaces. Brain Sci 2024; 14:138. [PMID: 38391713 PMCID: PMC10886993 DOI: 10.3390/brainsci14020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Brain spaces around (perivascular spaces) and alongside (paravascular or Virchow-Robin spaces) vessels have gained significant attention in recent years due to the advancements of in vivo imaging tools and to their crucial role in maintaining brain health, contributing to the anatomic foundation of the glymphatic system. In fact, it is widely accepted that peri- and para-vascular spaces function as waste clearance pathways for the brain for materials such as ß-amyloid by allowing exchange between cerebrospinal fluid and interstitial fluid. Visible brain spaces on magnetic resonance imaging are often a normal finding, but they have also been associated with a wide range of neurological and systemic conditions, suggesting their potential as early indicators of intracranial pressure and neurofluid imbalance. Nonetheless, several aspects of these spaces are still controversial. This article offers an overview of the current knowledge and magnetic resonance imaging characteristics of peri- and para-vascular spaces, which can help in daily clinical practice image description and interpretation. This paper is organized into different sections, including the microscopic anatomy of peri- and para-vascular spaces, their associations with pathological and physiological events, and their differential diagnosis.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro "Magna Græcia", 88100 Catanzaro, Italy
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Johan Van Goethem
- Department of Radiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
| | - Paul M Parizel
- Royal Perth Hospital & University of Western Australia, Perth, WA 6000, Australia
- Medical School, University of Western Australia, Perth, WA 6009, Australia
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Demir MK, Ertem Ö, Kundak NE, Ay T, Kılıc T. Extensive widening of Virchow-Robin spaces in the frontal lobe: two case reports and systematic review of the literature. Acta Neurol Belg 2023; 123:2129-2138. [PMID: 36273113 DOI: 10.1007/s13760-022-02098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Abstract
AIM To report our experience on giant tumefactive Virchow-Robin spaces (GTVRS) in the frontal lobe and perform a systematic review of previous reports on GTVRS. MATERIALS AND METHODS This is a retrospective single-center study reporting the clinical manifestations, magnetic resonance (MR) imaging appearance, differential diagnosis, and management of two patients diagnosed with frontal lobe GTVRS at Bahcesehir University School of Medicine Goztepe Hospital in the past 5 years. A systematic literature search was performed in the PubMed and Google Scholar databases, with case selection criteria including Virchow-Robin spaces (VRS) size greater than 1.5 cm, frontal lobe localization, and the presence of MR imaging. The search strategy included only English language keywords. The systematic review was searched between database inception and May 6, 2022. RESULTS A total of 18 cases were included in the study. Of the 15 cases with known sex, nine were female and six male. The median age was 29.8 with an age range of 4-57. Eleven of the 18 lesions were in the right frontal lobe. The lesions were multilocular in 15 cases and unilocular in three cases. All lesions had signal intensity as cerebrospinal fluid, showed no perifocal edema, and did not enhance. A hyperintensity was noted around the 14 lesions on the FLAIR sequence. Ten lesions showed cortical thinning adjacent to the lesion. No abnormality was detected on DWI, SWI, and MRS. Follow-up imaging was available in ten patients without any interval change. Unnecessary surgical interventions were noted in three cases. CONCLUSIONS The results of reported cases and the literature review emphasize the role of MR imaging in the diagnosis of frontal lobe GTVRS. Beyond diagnostic consideration, GTVRS may have prognostic value and often indicate a "don't touch lesion" albeit requiring further consideration on a case-to-case basis. Familiarity with this entity improves diagnostic accuracy and, prevents accidental diagnosis of any neoplasm or other diseases.
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Affiliation(s)
- Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, E5 Üzeri Merdivenköy, 23 Nisan Sokagi No:17, 34732, Kadıköy/Istanbul, Turkey.
- , 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158, Istanbul, Turkey.
| | - Önder Ertem
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, E5 Üzeri Merdivenköy, 23 Nisan Sokagi No:17, 34732, Kadıköy/Istanbul, Turkey
| | - Naz Ece Kundak
- Bahçeşehir University School of Medicine, E5 Üzeri Merdivenköy, 23 Nisan Sokagi No:17, 34732, Kadıköy/Istanbul, Turkey
| | - Tufan Ay
- Bahçeşehir University School of Medicine, E5 Üzeri Merdivenköy, 23 Nisan Sokagi No:17, 34732, Kadıköy/Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, E5 Üzeri Merdivenköy, 23 Nisan Sokagi No:17, 34732, Kadıköy/Istanbul, Turkey
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Lakha A, Thakar S. Giant Tumefactive Perivascular Spaces: An Unusual Cause of Holmes Tremor. World Neurosurg 2023; 179:66-67. [PMID: 37611803 DOI: 10.1016/j.wneu.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
A 34-year-old man presented with a 2-year history of medically refractory Holmes tremor in the right upper limb. Magnetic resonance imaging revealed a large, nonenhancing, multiseptate cystic lesion of cerebrospinal fluid intensity in the left thalamopeduncular region causing brainstem compression and hydrocephalus. A diagnosis of giant tumefactive perivascular spaces was made after a biopsy ruled out an infectious or neoplastic etiology. Significant clinicoradiologic improvement was noted following a ventriculoperitoneal shunt. Giant tumefactive perivascular spaces should be included as one of the rare differentials of a large, nonenhancing cystic lesion situated along the course of perforator vessels. Treatment options include cerebrospinal fluid diversion with or without cyst fenestration.
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Affiliation(s)
- Avinash Lakha
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
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Conforti R, Capasso R, Franco D, Russo C, Rinaldi FO, Pezzullo G, Coluccino S, Brunese MC, Caiazzo C, Caranci F, Tortora F. Giant Tumefactive Perivascular Space: Advanced Fusion MR Imaging and Tractography Study-A Case Report and a Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091602. [PMID: 37174993 PMCID: PMC10177987 DOI: 10.3390/diagnostics13091602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Perivascular spaces (PVSs) are small extensions of the subpial cerebrospinal space, pial-lined and interstitial fluid-filled. They surround small penetrating arteries, and veins, crossing the subarachnoid space to the brain tissue. Magnetic Resonance Imaging (MRI) shows a PVS as a round-shape or linear structure, isointense to the cerebrospinal fluid, and, if larger than 1.5 cm, they are known as giant/tumefactive PVSs (GTPVS) that may compress neighboring parenchymal/liquoral compartment. We report a rare asymptomatic case of GTPVS type 1 in a diabetic middle-aged patient, occasionally discovered. Our MRI study focuses on diffusion/tractography and fusion imaging: three-dimensional (3D) constructive interference in steady state (CISS) and time of fly (TOF) sequences. The advanced and fusion MR techniques help us to track brain fiber to assess brain tissue compression consequences and some PVS anatomic features as the perforating arteries inside them.
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Affiliation(s)
- Renata Conforti
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Raffaella Capasso
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Donatella Franco
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carmela Russo
- Unit of Neuroradiology, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, AORN, 80129 Naples, Italy
| | - Fabio Oreste Rinaldi
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giovanna Pezzullo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Simone Coluccino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Fabio Tortora
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, Federico II University, 80138 Naples, Italy
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8
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Okar SV, Hu F, Shinohara RT, Beck ES, Reich DS, Ineichen BV. The etiology and evolution of magnetic resonance imaging-visible perivascular spaces: Systematic review and meta-analysis. Front Neurosci 2023; 17:1038011. [PMID: 37065926 PMCID: PMC10098201 DOI: 10.3389/fnins.2023.1038011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesPerivascular spaces have been involved in neuroinflammatory and neurodegenerative diseases. Upon a certain size, these spaces can become visible on magnetic resonance imaging (MRI), referred to as enlarged perivascular spaces (EPVS) or MRI-visible perivascular spaces (MVPVS). However, the lack of systematic evidence on etiology and temporal dynamics of MVPVS hampers their diagnostic utility as MRI biomarker. Thus, the goal of this systematic review was to summarize potential etiologies and evolution of MVPVS.MethodsIn a comprehensive literature search, out of 1,488 unique publications, 140 records assessing etiopathogenesis and dynamics of MVPVS were eligible for a qualitative summary. 6 records were included in a meta-analysis to assess the association between MVPVS and brain atrophy.ResultsFour overarching and partly overlapping etiologies of MVPVS have been proposed: (1) Impairment of interstitial fluid circulation, (2) Spiral elongation of arteries, (3) Brain atrophy and/or perivascular myelin loss, and (4) Immune cell accumulation in the perivascular space. The meta-analysis in patients with neuroinflammatory diseases did not support an association between MVPVS and brain volume measures [R: −0.15 (95%-CI −0.40–0.11)]. Based on few and mostly small studies in tumefactive MVPVS and in vascular and neuroinflammatory diseases, temporal evolution of MVPVS is slow.ConclusionCollectively, this study provides high-grade evidence for MVPVS etiopathogenesis and temporal dynamics. Although several potential etiologies for MVPVS emergence have been proposed, they are only partially supported by data. Advanced MRI methods should be employed to further dissect etiopathogenesis and evolution of MVPVS. This can benefit their implementation as an imaging biomarker.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346564, identifier CRD42022346564.
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Affiliation(s)
- Serhat V. Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Fengling Hu
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Benjamin V. Ineichen
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Reproducible Science, University of Zurich, Zurich, Switzerland
- *Correspondence: Benjamin V. Ineichen, , ; orcid.org/0000-0003-1362-4819
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Hashida M, Nagashima Y, Nishimura Y, Eguchi K, Taoka T, Kawai H, Saito R. Spontaneous regression of asymptomatic tumefactive perivascular spaces in the anterior temporal lobe. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:678-685. [PMID: 36237891 PMCID: PMC9529622 DOI: 10.18999/nagjms.84.3.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Perivascular spaces are fluid-filled spaces that surround the perforating vessels of the brain and are normal findings on brain imaging. These are usually asymptomatic and are considered a manifestation of aging. Perivascular spaces occasionally undergo significant enlargement and are referred to as tumefactive perivascular spaces, which are often indistinguishable from neoplastic lesions. Spontaneous regression of tumefactive perivascular spaces during follow-up is rare. We report the imaging findings and clinical course of a patient who showed spontaneous regression of tumefactive perivascular spaces in the anterior temporal lobe, together with a literature review and discussion regarding the characteristics and pathogenesis of spontaneous regression of tumefactive perivascular spaces. Most studies in the available literature report tumefactive perivascular spaces in the anterior temporal lobe; in our view, the characteristics of anterior temporal lobe tumefactive perivascular spaces may differ from those of tumefactive perivascular spaces that occur at other locations.
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Affiliation(s)
- Miki Hashida
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaoru Eguchi
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisashi Kawai
- Department of Radiology, Aichi Medical University Graduate school of Medicine, Nagakute, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Yu L, Hu X, Li H, Zhao Y. Perivascular Spaces, Glymphatic System and MR. Front Neurol 2022; 13:844938. [PMID: 35592469 PMCID: PMC9110928 DOI: 10.3389/fneur.2022.844938] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/28/2022] [Indexed: 12/29/2022] Open
Abstract
The importance of the perivascular space (PVS) as one of the imaging markers of cerebral small vessel disease (CSVD) has been widely appreciated by the neuroradiologists. The PVS surrounds the small blood vessels in the brain and has a signal consistent with the cerebrospinal fluid (CSF) on MR. In a variety of physio-pathological statuses, the PVS may expand. The discovery of the cerebral glymphatic system has provided a revolutionary perspective to elucidate its pathophysiological mechanisms. Research on the function and pathogenesis of this system has become a prevalent topic among neuroradiologists. It is now believed that this system carries out the similar functions as the lymphatic system in other parts of the body and plays an important role in the removal of metabolic waste and the maintenance of homeostatic fluid circulation in the brain. In this article, we will briefly describe the composition of the cerebral glymphatic system, the influencing factors, the MR manifestations of the PVS and the related imaging technological advances. The aim of this research is to provide a reference for future clinical studies of the PVS and glymphatic system.
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Affiliation(s)
- Linya Yu
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haitao Li
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Haitao Li
| | - Yilei Zhao
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yilei Zhao
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11
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Bown CW, Carare RO, Schrag MS, Jefferson AL. Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain. Neurology 2022; 98:107-117. [PMID: 34810243 PMCID: PMC8792814 DOI: 10.1212/wnl.0000000000013077] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/29/2021] [Indexed: 01/21/2023] Open
Abstract
Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. Recent studies have demonstrated that enlarged PVS (ePVS) may have clinical consequences related to cognition. Emerging literature points to arterial stiffening and abnormal protein aggregation in vessel walls as 2 possible mechanisms that drive ePVS formation. We describe the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and in vivo quantification methods of ePVS. Given competing views of PVS physiology, we detail the 2 most prominent theoretical views and review ePVS associations with other common small vessel disease markers. Because ePVS are a marker of small vessel disease and ePVS burden is higher in Alzheimer disease, a comprehensive understanding about ePVS is essential in developing prevention and treatment strategies.
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Affiliation(s)
- Corey W Bown
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Roxana O Carare
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Matthew S Schrag
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Angela L Jefferson
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
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12
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Ayyildiz V, Koksal A, Taydas O, Ogul H. Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces. Acta Radiol 2021; 63:1554-1562. [PMID: 34839718 DOI: 10.1177/02841851211047240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms. PURPOSE To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions. MATERIAL AND METHODS The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography. RESULTS A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient. CONCLUSION Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.
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Affiliation(s)
- Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Ali Koksal
- Bayindir Private Hospital, Ankara, Turkey
| | - Onur Taydas
- Department of Radiology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
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13
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Yamaguchi Y, Wada M, Kimihira L, Nagasawa H. Cognitive impairment due to widespread enlarged perivascular spaces. Radiol Case Rep 2021; 16:2640-2645. [PMID: 34345324 PMCID: PMC8319478 DOI: 10.1016/j.radcr.2021.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022] Open
Abstract
Perivascular spaces, also known as Virchow-Robin spaces, are usually considered as a normal, asymptomatic finding. However, this finding can occasionally demonstrate an atypical appearance and can be symptomatic. We report herein a rare case of cognitive impairment associated with extremely enlarged perivascular spaces. A 68-year-old Japanese woman visited our hospital with a 1-year history of progressive memory impairment. In addition to temporal disorientation and short-term memory impairment, neuropsychological testing showed frontal lobe-related symptoms such as slowed thinking processes, reduced verbal fluency, attention deficit, and reduced working memory. Magnetic resonance imaging of the brain showed widespread enlarged perivascular spaces almost symmetrically in the subcortical white matter of bilateral hemispheres, prominently in bilateral insulas, and frontal opercula. On 99mTc-ethyl cysteinate dimer single photon emission computed tomography, hypoperfusion was apparent in bilateral insulas and frontal opercula where enlarged periventricular spaces were prominent, whereas cerebral perfusion was preserved in areas where enlargement of perivascular spaces was mild or absent. Because symptoms were consistent with the distribution of the enlarged perivascular spaces and hypoperfusion in the brain, cognitive impairment due to enlarged perivascular spaces was diagnosed. Clinicians should note enlarged perivascular spaces as a potential cause of neurological deficits including cognitive impairment.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Department of Neurology, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata 990-2292, Japan
| | - Manabu Wada
- Department of Neurology, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata 990-2292, Japan
| | - Luna Kimihira
- Department of Neurology, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata 990-2292, Japan
| | - Hikaru Nagasawa
- Department of Neurology, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata 990-2292, Japan
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14
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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15
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Opercular perivascular cysts: A proposed new subtype of dilated perivascular spaces. Eur J Radiol 2020; 124:108838. [PMID: 31972365 DOI: 10.1016/j.ejrad.2020.108838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Dilated perivascular spaces are a common finding on brain MRI, traditionally classified into three types based on location and relationship to vessels. Recent studies have characterised an additional variant of dilated perivascular spaces that arise within the anterior temporal lobe and have unique neuroimaging features. These particular perivascular spaces are associated with a vascular loop of a branch of the middle cerebral artery (MCA) and commonly demonstrate perilesional T2/FLAIR signal. To our knowledge, these have not previously been described in the frontal lobe. METHOD Dilated perivascular spaces associated with a vascular loop of a branch of the middle cerebral artery (MCA) identified at our institution were reviewed for imaging characteristics and anatomical location. RESULTS 18 cases were identified. 16 were located in the anterior temporal lobe and two were located in the frontal operculum. All demonstrated internal signal characteristics identical to CSF on all sequences, with no contrast enhancement or susceptibility artefact and variable perilesional T2/FLAIR signal. CONCLUSIONS We report further evidence of a distinct subtype of dilated perivascular spaces occurring in the anterior temporal lobe in association with a vascular loop of a branch of the MCA. In addition, we have demonstrated that these may also occur in the frontal operculum. We therefore suggest that these dilated perivascular spaces of the operculum be recognised as a separate, fourth, subtype of perivascular space and propose the term "opercular perivascular cyst".
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16
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Taydas O, Erarslan Y, Ates OF, Ogul H, Kantarci M. Tumefactive perivascular space demonstrated with post-contrast time-of-flight MR angiography. Neurochirurgie 2020; 66:50-52. [PMID: 31953071 DOI: 10.1016/j.neuchi.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/29/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
The cerebral perivascular spaces are interstitial fluid-filled anatomic structures surrounding the perforating arteries. They appear as small, round or curvilinear structures on magnetic resonance (MR) imaging. Occasionally, these structures may become very large and cause mass effect. In this case, they may imitate malignant processes and are referred to as tumefactive perivascular spaces. In this study, we present a case of tumefactive perivascular space demonstrated with post-contrast time-of-flight (TOF) MR angiography. To our knowledge, there have been no previous clear demonstrations of the perforating artery in tumefactive perivascular space with contrast-enhanced TOF MR angiography. The purpose of this study was to describe advanced imaging findings in this unusual condition.
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Affiliation(s)
- O Taydas
- Department of Radiology, Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
| | | | - O F Ates
- Sakarya Training and Research Hospital, Sakarya, Turkey
| | - H Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - M Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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17
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Henssen D, Meijer F. Cerebral aneurysm in a giant perivascular space. Neuroradiology 2019; 62:271-272. [DOI: 10.1007/s00234-019-02338-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
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