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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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2
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Zammit A, Tudose A, Khan N, Renowden S, Teo M. Perianeurysmal parenchymal cysts – Case series and literature review. BRAIN AND SPINE 2022; 2:100920. [PMID: 36248106 PMCID: PMC9560574 DOI: 10.1016/j.bas.2022.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Intracranial cysts are associated with a number of vascular lesions. They predominantly occur in larger, partially-thrombosed aneurysms and in older patients. There is a trend towards enlargement over time if untreated and a likelihood of recurrence following treatment. We hypothesise the cysts arise either from dilated Virchow-Robin spaces and/or inflammatory processes.
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3
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Bajwa MH, Ul Islam MY, Mubarak F. Giant tumefactive perivascular spaces in a pediatric patient: A rare radiological entity. Surg Neurol Int 2021; 12:613. [PMID: 34992929 PMCID: PMC8720451 DOI: 10.25259/sni_990_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/25/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Giant tumefactive perivascular spaces (TPVS) are radiological rarities and may mimic other neurological structural lesions. Fewer than 80 cases have been reported in the literature with even fewer in the pediatric population.
Case Description:
The authors present an image report showcasing a 3-year-old boy presenting with uncontrolled seizures despite multiple anti-epileptic medications. His magnetic resonance imaging showed multiple, non-contrast enhancing cyst clusters within the left parieto-occipital region that was hyperintense on T2-weighted imaging, and isointense to cerebrospinal fluid. Due to a characteristic absence of perilesional edema seen on fluid-attenuated inversion recovery imaging or diffusion restriction on diffusion-weighted imaging (DWI) sequences, this was diagnosed as a giant TPVS.
Conclusion:
Accurate diagnosis of these rare radiological entities is based on pathognomonic findings that can help prevent unnecessary surgery and guide management for patients, particularly in the pediatric population as seen in our case.
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Affiliation(s)
- Mohammad Hamza Bajwa
- Department of Neurosurgery, Aga Khan University Hospital, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammad Yousuf Ul Islam
- Department of Neurosurgery, Aga Khan University Hospital, Aga Khan University, Karachi, Sindh, Pakistan
| | - Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Aga Khan University, Karachi, Sindh, Pakistan
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4
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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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5
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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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6
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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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7
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Giant Tumefactive Perivascular Spaces: A Case Report and Literature Review. World Neurosurg 2018; 112:201-204. [DOI: 10.1016/j.wneu.2018.01.144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
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8
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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: 12] [Impact Index Per Article: 2.0] [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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9
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Kumar A, Gupta R, Garg A, Sharma BS. Giant Mesencephalic Dilated Virchow Robin Spaces Causing Obstructive Hydrocephalus Treated by Endoscopic Third Ventriculostomy. World Neurosurg 2015; 84:2074.e11-4. [DOI: 10.1016/j.wneu.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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10
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Zafar N, Alaid A, Rohde V, Mielke D. Intermittent visual field defects caused by a dilated Virchow–Robin space close to the optic radiation: Therapeutic and pathomechanical considerations. Br J Neurosurg 2015; 29:549-51. [DOI: 10.3109/02688697.2015.1019417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Revel F, Cotton F, Haine M, Gilbert T. Hydrocephalus due to extreme dilation of Virchow-Robin spaces. BMJ Case Rep 2015; 2015:bcr2014207109. [PMID: 25564639 PMCID: PMC4289809 DOI: 10.1136/bcr-2014-207109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/04/2022] Open
Abstract
Virchow-Robin spaces (VRS) are extensions of the subarachnoid space surrounding perforating blood vessels entering the brain parenchyma. VRS are fluid filled, but almost virtual and only visible on MRI of the brain when dilated. Such dilations are commonly asymptomatic. In rare cases, extreme dilations can be observed; the clinical repercussions of which remain unclear. We report the case of a patient presenting symptoms of normal pressure hydrocephalus due to extreme VRS mesencephalon dilations.
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Affiliation(s)
- Frederic Revel
- Centre Hospitalier Lyon-Sud, Service de médecine gériatrique, Hospices civils de Lyon, Pierre-Bénite, France
- Université Lyon 1, Villeurbanne, France
| | - Francois Cotton
- Service de Radiologie, Université Lyon 1, Laboratoire d'Anatomie de Rockefeller, Lyon et Hospices civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- CNRS UMR 5220, Université de Lyon, Université Lyon 1, CREATIS-LRMN, Villeurbanne, France
| | - Max Haine
- Service de médecine gériatrique, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Thomas Gilbert
- Service de médecine gériatrique, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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12
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Mölzer G, Robinson S. Case 202: Extensive Unilateral Widening of Virchow-Robin Spaces. Radiology 2014; 270:623-6. [DOI: 10.1148/radiol.13110419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Bilginer B, Narin F, Hanalioglu S, Oguz KK, Akalan N. Virchow-Robin spaces cyst. Childs Nerv Syst 2013; 29:2157-62. [PMID: 23896867 DOI: 10.1007/s00381-013-2240-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Burcak Bilginer
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey,
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14
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Fiorindi A, Delitala A, Francaviglia N, Longatti P. Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature. Clin Neurol Neurosurg 2013; 115:2370-6. [DOI: 10.1016/j.clineuro.2013.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/18/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022]
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15
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Gronier S, Ayrignac X, Lamy C, Honnorat J, Thomas P, Lebrun-Frenay C, Labauge P. [Symptomatic giant Virchow-Robin spaces]. Rev Neurol (Paris) 2013; 169:898-902. [PMID: 24119855 DOI: 10.1016/j.neurol.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/25/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Perivascular spaces, known as Virchow-Robin spaces (VRS), may become massively enlarged but are usually an incidental finding. However, a few reports on patients with unusually large VRS have mentioned association with neurological symptoms. We report a series of three symptomatic patients with extremely wide Virchow-Robin spaces documented on brain magnetic resonance imaging (MRI). METHODS We retrospectively analyzed the medical records and brain MRI of three symptomatic patients, who had been diagnosed with VRS widening. CASE REPORTS In all three patients, the unusual widening of the VRS was located within the subcortical white matter with asymmetric distribution. Their neurological symptoms were epilepsy and neurological deficits which correlated well with the lesions seen on the MRI. Two patients had associated white matter hyperintensities: in the first case associated gliosis and in the second case, with vascular leukoencephalopathy. CONCLUSIONS Enlarged symptomatic VRS are rare. The underlying pathophysiological mechanisms remain uncertain. We report three cases with symptomatic giant dilatation of the Virchow-Robin spaces.
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Affiliation(s)
- S Gronier
- Service de neurologie, pôle de neurosciences cliniques, CHU de Nice, hôpital Pasteur, 30, voie Romaine, 06002 Nice cedex 1, France
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16
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Fujimoto K, Kuroda JI, Hide T, Hasegawa Y, Yano S, Kuratsu JI. Giant tumefactive perivascular spaces that expanded and became symptomatic 14 years after initial surgery. Surg Neurol Int 2012; 3:127. [PMID: 23227432 PMCID: PMC3513852 DOI: 10.4103/2152-7806.102942] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/19/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Perivascular spaces (PVSs) or Virchow-Robin spaces in the brain are pial-lined interstitial fluid (ISF)-filled structures surrounding the penetrating arteries and arterioles. These spaces appear as 1- to 2-mm in diameter, round, oval, or curvilinear smooth-walled structures on magnetic resonance imaging (MRI). Typical PVSs are asymptomatic. Occasionally, they become enlarged and cause specific clinical manifestations that depend on location and the degree of tissue compression. In this case, they are referred to as giant tumefactive PVSs. To our knowledge, there have been no reported cases in which giant PVSs increased remarkably in number and size during both the natural course and postoperative course. We describe a rare progression of giant tumefactive PVSs 14 years after initial surgery. CASE DESCRIPTION On first admission at age 17, endoscopic ventriculocystostomy and third ventriculostomy were performed to relieve hydrocephalus caused by cysts compressing the cerebral aqueduct. Fourteen years later, the multicystic lesion reappeared with an increase in both cyst number and size. The patient showed no hydrocephalus but presented with oculomotor and trochlear nerve palsies, which were caused by a mass effect on the midbrain. Endoscopic ventriculocystostomy was performed and symptoms improved. CONCLUSION This is the first case report in which giant PVSs increased significantly in number and size.
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Affiliation(s)
- Kenji Fujimoto
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
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17
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Algin O, Conforti R, Saturnino P, Ozmen E, Cirillo M, Di Costanzo A, De Cristofaro M, Rotondo M, Cirillo S. Giant Dilatations of Virchow-Robin Spaces in the Midbrain. Neuroradiol J 2012; 25:415-22. [DOI: 10.1177/197140091202500404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/23/2012] [Indexed: 11/16/2022] Open
Abstract
Virchow-Robin spaces are lesions often seen in the brain parenchyma but their etiopathogenesis remains unsettled. Giant Virchow-Robin spaces placed in the midbrain are extremely rare. We describe three patients with a diagnosis of giant Virchow-Robin spaces in the midbrain, and their clinical and radiologic findings. We reviewed the literature in terms of the etiopathology, anatomic and radiologic appearance and differential diagnosis of the giant Virchow-Robin spaces. The diagnostic role of the high Tesla magnetic resonance devices and new sequences techniques such as three dimensional isotropic acquisition and diffusion tensor imaging were also evaluated in this case series.
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Affiliation(s)
- O. Algin
- Department of Radiology, Ataturk Training and Research Hospital; Bilkent, Ankara, Turkey
| | - R. Conforti
- “F. Magrassi and A. Lanzara” Department of Clinical and Experimental Internal Medicine and Surgery
| | - P.P. Saturnino
- “F. Magrassi and A. Lanzara” Department of Clinical and Experimental Internal Medicine and Surgery
| | - E. Ozmen
- Department of Radiology, Ataturk Training and Research Hospital; Bilkent, Ankara, Turkey
| | - M. Cirillo
- “F. Magrassi and A. Lanzara” Department of Clinical and Experimental Internal Medicine and Surgery
| | - A. Di Costanzo
- Department of Neurology, University of Molise; Isernia, Italy
| | - M. De Cristofaro
- Department of Neurosciences, Second University of Naples; Naples, Italy
| | - M. Rotondo
- Department of Neurosurgery, Second University of Naples; Naples, Italy
| | - S. Cirillo
- “F. Magrassi and A. Lanzara” Department of Clinical and Experimental Internal Medicine and Surgery
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18
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Yang SH, Kulkarni AV. Successful treatment of tremor by endoscopic third ventriculostomy in an adolescent with obstructive hydrocephalus due to tectal glioma: case report. Childs Nerv Syst 2011; 27:1007-10. [PMID: 21369786 DOI: 10.1007/s00381-011-1404-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
Hydrocephalus presenting with movement disorder is very rare, especially in children. We present the case of a 16-year-old boy who presented with bilateral intention tremor and slowed speech as a result of obstructive hydrocephalus secondary to a tectal glioma. Treatment with endoscopic third ventriculostomy improved his symptoms. We review the literature regarding this unusual presentation of an otherwise common condition.
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Affiliation(s)
- Shih-Hung Yang
- Division of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
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19
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Asymmetric Dilatation of Virchow-Robin Space in Unilateral Internal Carotid Artery Steno-Occlusive Disease. J Comput Assist Tomogr 2011; 35:298-302. [DOI: 10.1097/rct.0b013e31820baf1e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Sturiale CL, Albanese A, Lofrese G, Frassanito P, Sabatino G, Marchese E, Puca A. Pathological enlargement of midbrain Virchow-Robin spaces: a rare cause of obstructive hydrocephalus. Br J Neurosurg 2010; 25:130-1. [PMID: 20825291 DOI: 10.3109/02688697.2010.504050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Midbrain multiloculated cystic formations can rarely origin by enlargement of Virchow-Robin spaces surrounding mesencephalo-thalamic artery and branches of the collicular and accessory collicular arteries. They can determine several pictures of midbrain syndrome and obstructive hydrocephalus. The authors describe a 38 year-old man affected by a Benedikt's syndrome related to a midbrain multicystic formation. Clinical course, differential diagnosis, and therapeutic choice are here also briefly discussed.
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21
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Muda AS, Kwah Y, Al-Edrus S, Wong S, Norzaini M, Viswanathan S. An Unusual Cause of Blepharospasm. Neuroradiol J 2010; 23:443-6. [DOI: 10.1177/197140091002300413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022] Open
Abstract
We describe a rare case of multiple dilated Virchow-Robin spaces in the brainstem in a patient presenting initially with blepharospasm with subsequent spread to involve the face and neck. On magnetic resonance imaging (MRI), these lesions demonstrated an isointense signal to cerebrospinal fluid on all sequences with no mass effect or enhancement. Although rare, this condition should be considered part of the differential diagnosis when evaluating cystic abnormalities in the brainstem. This is the first reported case of blepharospasm with subsequent orofacial and neck dystonia caused by dilated Virchow-Robin spaces. The imaging findings and differential diagnoses are discussed.
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Affiliation(s)
- A. Sobri Muda
- Radiology Department, Kebangsaan University, Malaysia Medical Centre; Kuala Lumpur, Malaysia
| | - Y.G. Kwah
- Radiology Department, Kebangsaan University, Malaysia Medical Centre; Kuala Lumpur, Malaysia
| | - S.A. Al-Edrus
- Faculty of Medicine and Health Sciences, Putra University; Upm Serdang, Selangor, Malaysia
| | - S.L. Wong
- Radiology Department, Malaysia University; Serawak, Malaysia
| | - M.Z. Norzaini
- Radiology Department, Kuala Lumpur Hospital; Kuala Lumpur, Malaysia
| | - S. Viswanathan
- Neurology Department, Kuala Lumpur Hospital; Kuala Lumpur, Malaysia
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22
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Bruna AL, Martins I, Husson B, Landrieu P. Developmental dilatation of Virchow-Robin spaces: a genetic disorder? Pediatr Neurol 2009; 41:275-80. [PMID: 19748047 DOI: 10.1016/j.pediatrneurol.2009.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 04/15/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
Abstract
In childhood, widening of Virchow-Robin spaces is rarely secondary to specific progressive disorders, but more often appears in poorly characterized developmental conditions. From data collected in a neuropediatric department, we examined whether clinical data associated with "constitutional widening of Virchow-Robin spaces" allowed delineation of recognizable entities. Signs in 10 patients, mostly boys, suggested nonspecific cerebral dysfunctions, e.g., developmental delay, nonspecific epilepsy, headaches, or benign macrocephaly. Spaces were sometimes round, subsequently mimicking microcystic malacic lesions. In two patients, abnormal magnetic resonance imaging signals were evident in white matter contiguous to widened perivascular spaces, suggesting a broader disorder of fluid exchanges. Four cases occurred in two sibships. In two families, other patients exhibited early developmental difficulties. Long-term clinical and magnetic resonance imaging surveillance will clarify which cases of primary Virchow-Robin space dilatation imply a benign prognosis. Performance of magnetic resonance imaging on any relative exhibiting minor neuropsychologic handicaps would permit estimations of real genetic incidence.
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Affiliation(s)
- Anne-Laure Bruna
- Service de Neurologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, 94270 Kremlin-Bicêtre, France
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23
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Lefranc M, Peltier J, Bugnicourt JM, Lamy C, Deramond H, Toussaint P, Le Gars D. [Giant cystic widening of Virchow-Robin spaces, case report]. Morphologie 2008; 92:82-6. [PMID: 18809350 DOI: 10.1016/j.morpho.2008.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Virchow-Robin spaces are very well-known anatomical and radiological entities. However, the observation of giant cystic widening of Virchow-Robin spaces is anecdotic. We report herein the case of a patient presenting with giant cystic widening of Virchow-Robin spaces located in both cerebral hemispheres. OBSERVATION A 26-year-old female presented with numbness of left arm and then, of both arms. CT scan showed many hypodensities located in the two hemispheres. Neurologic examination was normal. MR imaging allowed the diagnosis of giant cystic widening Virchow-Robin spaces in T2, T2*, T1 gadolinium and Flair weighted images. Neuropsychological investigations were normal. CONCLUSION Giant cystic widening of Virchow-Robin spaces are extremely rare entities. MR imaging helps the diagnosis. Only extreme dilatation of Virchow-Robin perivascular spaces close to ventricular system must be watched and treated in case of an obstructive hydrocephalus risk. When located in cerebral hemispheres, these dilatations are mostly asymptomatic and must not be confused with a cystic tumoral disease.
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Affiliation(s)
- M Lefranc
- Service de neurochirurgie, CHU d'Amiens, 5, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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Endo H, Fujimura M, Watanabe M, Tominaga T. Neuro-endoscopic management of mesencephalic intraparenchymal cyst: a case report. ACTA ACUST UNITED AC 2008; 71:107-10; discussion 110. [PMID: 18291476 DOI: 10.1016/j.surneu.2007.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intraparenchymal cyst of the mesencephalon is rare, and its natural course is unclear. The optimal treatment for this entity is still undetermined. CASE DESCRIPTION A 54-year-old woman was found to have asymptomatic multilobulated mesencephalic cysts. Two years after the initial diagnosis, she experienced headache and double vision, when MRI showed the enlargement of the multilobulated cystic lesions which markedly compressed the mesencephalon and the aqueduct, resulting in noncommunicating hydrocephalus. She underwent diagnostic endoscopic biopsy and ETV by flexible endoscopic system, which revealed the mesensephalic cyst wall at the dorsal part of the third ventricle floor. A part of the cyst membrane was carefully excised by endoscopic forceps without injuring the surrounding structures. Histopathological examination revealed that the cyst wall was exclusively neuroglial tissue, and the presence of neoplasm was ruled out. Her symptoms were relieved immediately after surgery, and postoperative MRI showed both the shrinkage of mesencephalic cysts and the improvement of hydrocephalus. There is no recurrence of her symptoms, and MRI findings have been stable during the 3 year follow-up period. CONCLUSION Intraparenchymal cysts of the mesencephalon have an expanding nature. Once those cysts become symptomatic, we recommend endoscopic procedure including decompression and biopsy of the cyst with ETV.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
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Marnet D, Noudel R, Peruzzi P, Bazin A, Bernard MH, Scherpereel B, Pluot M, Rousseaux P. [Dilatation of Virchow-Robin perivascular spaces (types III cerebral lacunae): radio-clinical correlations]. Rev Neurol (Paris) 2007; 163:561-71. [PMID: 17571024 DOI: 10.1016/s0035-3787(07)90462-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Virchow-Robin spaces are pia-lined extensions of the subarachnoid space surrounding the path of brain vessels. When enlarged, such dilated perivascular spaces are often seen as foci of cerebrospinal fluid signal on MRI or CT scan. These foci are found in patients with miscellaneous clinical status. It is necessary to determine the radiological significance and clinical associations, if any, in such patients in order to give them the appropriate treatment. METHODS We describe the clinical and radiological findings of five patients and review the literature on perivascular Virchow-Robin spaces. RESULTS The mechanisms of dilated Virchow-Robin spaces are still not well understood. Such dilated perivascular spaces are found in two locations: typically in the high-convexity white matter of healthy elderly subjects, or surrounding the lenticulostriate vessels as they enter the basal ganglia. On MR images, they may be confused with lacunar infarcts. Most of the patients present with no symptoms: small dilatations located in the high convexity actually represent an anatomic variant, also called "état criblé". Sometimes, giant dilatations, or Poirier's type IIIb "expanding lacunae", found in the basal ganglia and midbrain may result in symptomatic hydrocephalus needing appropriate treatment. For other miscellaneous symptoms as headache, generalized epilepsy, dysmorphy, macrocephaly, there is no reliable correlation with enlarged perivascular spaces seen on MR images. CONCLUSIONS The real symptomatic dilated perivascular spaces need appropriate and quick treatment. Most of the other patients present with no symptoms and will remain asymptomatic.
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Affiliation(s)
- D Marnet
- Service de neurochirurgie, Hôpital Maison Blanche, CHU de Reims, 45 rue Cognacq Jay, 51092, Reims Cedex.
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Abstract
Virchow-Robin (VR) spaces surround the walls of vessels as they course from the subarachnoid space through the brain parenchyma. Small VR spaces appear in all age groups. With advancing age, VR spaces are found with increasing frequency and larger apparent sizes. At visual analysis, the signal intensity of VR spaces is identical to that of cerebrospinal fluid with all magnetic resonance imaging sequences. Dilated VR spaces typically occur in three characteristic locations: Type I VR spaces appear along the lenticulostriate arteries entering the basal ganglia through the anterior perforated substance. Type II VR spaces are found along the paths of the perforating medullary arteries as they enter the cortical gray matter over the high convexities and extend into the white matter. Type III VR spaces appear in the midbrain. Occasionally, VR spaces have an atypical appearance. They may become very large, predominantly involve one hemisphere, assume bizarre configurations, and even cause mass effect. Knowledge of the signal intensity characteristics and locations of VR spaces helps differentiate them from various pathologic conditions, including lacunar infarctions, cystic periventricular leukomalacia, multiple sclerosis, cryptococcosis, mucopolysaccharidoses, cystic neoplasms, neurocysticercosis, arachnoid cysts, and neuroepithelial cysts.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Ahmad FU, Garg A, Singh M, Mishra NK. Giant mesencephalothalamic virchow-robin spaces causing obstructive hydrocephalus. A case report. Neuroradiol J 2007; 20:303-6. [PMID: 24299672 DOI: 10.1177/197140090702000310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 04/22/2007] [Indexed: 11/16/2022] Open
Abstract
Virchow-Robin spaces accompany arteries for a variable distance into the brain substance. They are usually small but can be identified on high resolution MRI images in patients of all age groups. We report a rare case of a 40-year-old woman with giant mesencephalothalamic Virchow-Robin spaces which caused hydrocephalus requiring CSF diversion. After right ventriculoperitoneal shunt the patient recovered completely.
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Affiliation(s)
- F U Ahmad
- All India Institute of Medical Sciences; New Delhi, India -
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Guermazi A, Miaux Y, Rovira-Cañellas A, Suhy J, Pauls J, Lopez R, Posner H. Neuroradiological findings in vascular dementia. Neuroradiology 2006; 49:1-22. [PMID: 17115204 DOI: 10.1007/s00234-006-0156-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 08/30/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are multiple diagnostic criteria for vascular dementia (VaD) that may define different populations. Utilizing the criteria of the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) has provided improved consistency in the diagnosis of VaD. The criteria include a table listing brain imaging lesions associated with VaD. METHODS The different neuroradiological aspects of the criteria are reviewed based on the imaging data from an ongoing large-scale clinical trial testing a new treatment for VaD. The NINDS-AIREN criteria were applied by a centralized imaging rater to determine eligibility for enrollment in 1,202 patients using brain CT or MRI. RESULTS Based on the above data set, the neuroradiological features that are associated with VaD and that can result from cerebral small-vessel disease with extensive leukoencephalopathy or lacunae (basal ganglia or frontal white matter), or may be the consequence of single strategically located infarcts or multiple infarcts in large-vessel territories, are illustrated. These features may also be the consequence of global cerebral hypoperfusion, intracerebral hemorrhage, or other mechanisms such as genetically determined arteriopathies. CONCLUSION Neuroimaging confirmation of cerebrovascular disease in VaD provides information about the topography and severity of vascular lesions. Neuroimaging may also assist with the differential diagnosis of dementia associated with normal pressure hydrocephalus, chronic subdural hematoma, arteriovenous malformation or tumoral diseases.
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Affiliation(s)
- Ali Guermazi
- Department of Radiology Services, Synarc Inc., 575 Market Street, San Francisco, CA 94105, USA.
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Groeschel S, Chong WK, Surtees R, Hanefeld F. Virchow-Robin spaces on magnetic resonance images: normative data, their dilatation, and a review of the literature. Neuroradiology 2006; 48:745-54. [PMID: 16896908 DOI: 10.1007/s00234-006-0112-1] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 05/13/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Virchow-Robin spaces (VRS) are perivascular spaces in the brain and can be visualized on magnetic resonance images (MRI). We attempt to provide a better understanding of the significance of VRS for pathological and physiological processes by reviewing the literature, presenting normative data for the first time, and proposing a definition for the dilatation of the VRS on MRI that is based on shape rather than size. METHODS We evaluated the VRS in 125 healthy subjects (age range 1-30 years) using high-resolution 3D images, and in 36 patients (age range 2-16 years) with normal MRI, using routine clinical sequences. RESULTS VRS were visible in all high-resolution images of the 125 healthy subjects. Two of them revealed dilated VRS, giving a prevalence of 1.6%. VRS could be visualized in 29 (80%) of the 36 paediatric clinical scans; none was dilated. It was demonstrated that the visibility of VRS on MRI is sequence-dependent. CONCLUSION From the results of this study and the literature on the nature and pathology of VRS, we conclude that VRS on MR images of healthy individuals are normal findings, even if they are dilated. A judgement on whether dilated VRS in an individual patient is a normal variant or part of a disease process can be made by taking into account the appearance of the adjacent tissue on MRI and the clinical context.
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Affiliation(s)
- Samuel Groeschel
- Department of Pediatrics and Child Neurology, Georg-August-University, Goettingen, Germany
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Krause M, Hähnel S, Haberkorn U, Meinck HM. Dopa–responsive hemiparkinsonism due to midbrain Virchow–Robin spaces? J Neurol 2005; 252:1555-7. [PMID: 16284714 DOI: 10.1007/s00415-005-0890-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 03/30/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
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Rohlfs J, Riegel T, Khalil M, Iwinska-Zelder J, Mennel HD, Bertalanffy H, Hellwig D. Enlarged perivascular spaces mimicking multicystic brain tumors. J Neurosurg 2005; 102:1142-6. [PMID: 16028777 DOI: 10.3171/jns.2005.102.6.1142] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors present two cases in which enlarged Virchow—Robin spaces were located in the basal ganglia and the thalamomesencephalic region. The incidence of such huge cystic lesions is extremely rare. The expanding nature of these lesions, demonstrated by the patients' progressive symptoms due to compression of the adjacent brain parenchyma and obstructive hydrocephalus, mimicked that of brain tumors. The two patients were successfully treated by neuroendoscopic cystocisternostomy or ventriculocystostomy. To the authors' knowledge there have been only two published reports on expanding Virchow—Robin spaces that produced a compressive effect or consequent hydrocephalus and were directly fenestrated using neuroendoscopic techniques. Neuroendoscopy appears to offer an effective surgical option in the treatment of symptomatic Virchow—Robin spaces.
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Affiliation(s)
- Jochen Rohlfs
- Department of Neurosurgery, Philipps University, Marburg, Germany.
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House P, Salzman KL, Osborn AG, MacDonald JD, Jensen RL, Couldwell WT. Surgical considerations regarding giant dilations of the perivascular spaces. J Neurosurg 2004; 100:820-4. [PMID: 15137600 DOI: 10.3171/jns.2004.100.5.0820] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Dilations of brain perivascular spaces (PVSs), also known as Virchow—Robin spaces, are routinely identified on magnetic resonance imaging studies of the brain and recognized as benign normal variants. Giant dilations occur only rarely and can be easily misdiagnosed as central nervous system tumors. The relevant surgical literature was reviewed to help establish indications for surgical intervention in these typically benign lesions.
Methods. Giant dilations of the PVSs in 12 patients who had undergone surgery for several different indications were identified. Both clinical and radiographic presentations of these patients were reviewed along with the surgical procedures.
Conclusions. Dilations of the PVSs can become giant lesions that may necessitate surgical intervention to relieve mass effect or hydrocephalus. The relationship of these lesions to neurological symptoms such as tremor and seizures remains unclear.
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Affiliation(s)
- Paul House
- Department of Neurological Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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