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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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2
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Stuebe CM, Gonzalez NM, Toussaint LG. Enlarged Virchow-Robin Spaces Contributing to Ventriculomegaly in a 37-Year-Old Woman. Neurology 2023; 101:1077-1078. [PMID: 37816640 PMCID: PMC10752641 DOI: 10.1212/wnl.0000000000207950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/12/2023] Open
Affiliation(s)
- Caren M Stuebe
- From the Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan
| | - Nancy M Gonzalez
- From the Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan
| | - L Gerard Toussaint
- From the Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan.
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3
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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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Sadashiva N, Saini J. Dilated Virchow Robin spaces in brainstem. Br J Neurosurg 2023; 37:307-308. [PMID: 32909842 DOI: 10.1080/02688697.2020.1817854] [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: 04/01/2020] [Revised: 07/06/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
Virchow Robin spaces are normally found pial-lined perivascular spaces traversing from subarachnoid space to the brain parenchyma. Giant dilated Virchow robin spaces (dVRS) are rare. They do not require any surgical intervention unless they are causing symptoms. Here we report a young boy with an incidentally detected giant dVRS in brainstem which was referred for surgery with an initial impression of glioma. Knowledge about such an entity is important to prevent mismanagement.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroradiology and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, 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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Khoulali M, Mehfoud I, Mejdoubi A, Khay H, Guini M, Oulali N, Moufid F, Mebrouk Y, Bkyer H, Housni B. Endoscopic Infratentorial Supracerebellar approach for the mesencephalic enlarged Virchow Robin Space fenestration, an alternative minimally invasive route. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Donigian AJ, Toupin DN, Lightner D, Guduru Z. Acquired Movement Disorders Secondary to Giant Tumefactive Perivascular Spaces. J Mov Disord 2021; 14:251-253. [PMID: 33819421 PMCID: PMC8490187 DOI: 10.14802/jmd.20112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - David Neil Toupin
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Donita Lightner
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Zain Guduru
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
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Idiculla PS, Gurala D, Siddiqui JH. Giant tumefactive perivascular spaces: an incidental finding. Acta Neurol Belg 2020; 120:1443-1444. [PMID: 32856207 DOI: 10.1007/s13760-020-01481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
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Okada T, Makimoto K, Itoh K, Moinuddin FM, Yoshimoto K, Arita K. The first 3-D volumetric analysis of mesencephalothalamic giant perivascular spaces showing steady and slow growth over 17 years. Surg Neurol Int 2020; 11:300. [PMID: 33093977 PMCID: PMC7568101 DOI: 10.25259/sni_423_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Giant perivascular spaces (PVSs) are very rare condition in the brain and can be associated with neurological symptoms. It often enlarges and causes obstructive hydrocephalus which requires surgical intervention. However, the growth velocity has never been investigated. Case Description: Here, we report a woman in her early eighties with giant PVSs eventually followed up 17 years. She presented with dizziness and mild headache for a week and her neurological examination showed no abnormality. Her brain magnetic resonance imaging (MRI) showed a multiple cystic lesion, 28 mm in maximum diameter as a whole, in the left mesencephalothalamic region. There were no solid part, rim enhancement, or perilesional intensity change suggesting edema or gliosis. Smaller PVSs were also seen in bilateral-hippocampi, basal ganglia, white matter, and left frontal operculum. Retrospectively, five MRI studies over 17 years were analyzed using a 3-D volumetric software and found a very slow growth of the lesion, from 6.54 ml to 9.83 ml indicating gain of 0.1752 ml (2.68%) per year. Conclusion: This is the first report verifying a gradual enlargement of giant PVSs in a natural course. The prospective 3-D volumetric analysis on PVSs may elucidate the true nature of these lesions.
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Affiliation(s)
- Tomohisa Okada
- Department of Neurosurgery, Izumi Regional Hospital, Kagoshima, Japan
| | - Kaisei Makimoto
- Department of Radiology, Izumi Regional Hospital, Kagoshima, Japan
| | - Kayoko Itoh
- Department of Neurology, Uchiyama Hospital, Akune, Kagoshima, Japan
| | - F M Moinuddin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Koji Yoshimoto
- Department of Neurosurgery, Kagoshima University, Sakuragaoka, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Izumi Regional Hospital, Kagoshima, Japan.,Department of Neurosurgery, Kagoshima University, Sakuragaoka, Kagoshima, Japan
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Mark IT, Carr CM, Ruff MW, Flanagan EP, Johnson DR. Enlarging Perivascular Spaces Following Radiation Therapy in the Brain: A Report of 2 Cases and Literature Review. World Neurosurg 2020; 138:436-439. [PMID: 32251809 DOI: 10.1016/j.wneu.2020.03.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Virchow-Robin or enlarged perivascular spaces (PVS) are benign pial-lined spaces that surround penetrating arteries and arterioles through the brain parenchyma. We present 2 cases of enlarging PVS in adults following whole-brain radiation therapy. CASE DESCRIPTION Two patients underwent whole-brain radiation therapy for adult-onset medulloblastoma. Neither patient had enlarged PVS at the time of radiation treatment. The patients presented with PVS in the basal ganglia 6 and 8 years following the completion of radiation, respectively. One patient subsequently showed a decrease in size of PVS over time. Neither patient experienced symptoms, required surgical intervention, or had signs of tumor recurrence. CONCLUSIONS Enlarging PVS can occur years after radiation therapy to the brain parenchyma. Recognition of these benign PVS is important so as not to mistake the changes for more sinister pathology that could lead to unnecessary intervention. Moreover, focal cystic changes more frequently seen surrounding areas of focal brain radiation therapy might represent enlarged PVS.
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Affiliation(s)
- Ian T Mark
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael W Ruff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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De Schlichting E, Zaldivar-Jolissaint JF, Castrioto A, Reyns N, Chabardès S. Reversible Focal Dystonia Secondary to Giant Perivascular Spaces. Stereotact Funct Neurosurg 2020; 98:80-84. [PMID: 32050205 DOI: 10.1159/000505711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022]
Abstract
Giant perivascular spaces (PVS) are rare, CSF-filled, dilated cavities lined by the pia mater that are most often asymptomatic radiological findings but can sometimes cause neurological symptoms. We present two exceptional cases of secondary focal dystonia induced by the mass effect on the basal ganglia caused by giant diencephalic PVSs. In both cases, we chose a surgical stereotactic drainage approach as a treatment strategy that allowed controlling the movement disorders. The beneficial therapeutic effect was sustained at long-term follow-up. We believe that similar cases could be addressed successfully with this method.
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Affiliation(s)
- Emmanuel De Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), La Tronche, France,
| | | | - Anna Castrioto
- Movement Disorders Center, Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1216, Grenoble, France
| | - Nicolas Reyns
- Service de Neurochirurgie, Centre Hospitalier Régional Universitaire de Lille (CHRUL), Lille, France
| | - Stephan Chabardès
- Service de Neurochirurgie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), La Tronche, France.,Clinatec, Grenoble, France
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Kwee RM, Kwee TC. Tumefactive Virchow-Robin spaces. Eur J Radiol 2019; 111:21-33. [DOI: 10.1016/j.ejrad.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/01/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
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13
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Woo PYM, Cheung E, Zhuang JTF, Wong HT, Chan KY. A Giant Tumefactive Perivascular Space: A Rare Cause of Obstructive Hydrocephalus and Monoparesis. Asian J Neurosurg 2018; 13:1295-1300. [PMID: 30459922 PMCID: PMC6208240 DOI: 10.4103/ajns.ajns_108_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cerebral perivascular spaces (PVSs), otherwise known as Virchow-Robin spaces, are interstitial fluid-filled channels, <2 mm in diameter that form around arterial perforators as they course from the cortex into the brain parenchyma. In contrast, a giant tumefactive PVS is a rare entity comprising of clusters of such channels larger than 15mm resembling a neoplastic process as the name suggests. We report a 55-year-old male who presented with unsteady gait, cognitive decline, and left lower limb weakness for 6 months. Magnetic resonance imaging revealed a noncontrast enhancing multicystic intraaxial lesion of the right mesencephalon-diencephalon junction extending into the anterior third ventricle causing obstructive hydrocephalus. A ventriculoperitoneal shunt was inserted with a complete reversal of his neurological symptoms. Such PVSs can easily be misidentified for a cystic tumor, and their unique radiological features are discussed to prevent unnecessary surgery. We also demonstrate that when they cause hydrocephalus and midbrain compression symptoms cerebrospinal fluid shunting alone can result in excellent outcomes.
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Affiliation(s)
| | - Eric Cheung
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | | | - Hoi-Tung Wong
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
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