Enlarged perivascular spaces mimicking multicystic brain tumors

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.

Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature

“…They associated ETV with cyst wall biopsy, observing radiological and clinical improvement of the headache and right arm and leg weakness. Rohlfs et al described two cases of enlarged perivascular spaces of the basal ganglia-thalamo-mesencephalic region successfully treated with the endoscope [4]. In both cases the cysts were opened, one into the third ventricle, the other into the interpeduncular cistern, with resolution of the clinical disturbances in both (hemihypesthesia and tremor of the left hand respectively).…”

“…Ventriculo-peritoneal (V-P) shunting has been used with obvious relief of the clinical signs of hydrocephalus [10,19], but leaves the cyst intact, with the midbrain compressive syndrome being treated medically with limited effects. Rohlfs and colleagues also agreed that placement of a CSF shunt or ETV were treatment options for hydrocephalus, but these procedures do not improve the focal symptoms nor arrest growth of the cystic lesion [4]. They also concluded that ventriculo-cystostomy or cyst-cisternostomy is needed to effectively treat cysts causing brainstem compression.…”

“…4b), and the patient's signs and symptoms regressed, except for the oculomotor deficit. authors: expanding lacunae [7,9,10], expanding Virchow-Robin spaces [11], benign expanding cerebral cysts [7], giant dilations of perivascular spaces [3,5,12] or enlarged perivascular spaces [4,13], and oddly enough, virchomas [5]. Some of the names clearly recall the possible pathogenesis of these cystic lesions, considered by most authors to be merely an excessive dilation of Virchow-Robin physiological perivascular spaces (PVSs), which can be found anywhere in the brain [14].…”

“…These cysts are generally interpreted as dilations of Virchow-Robin spaces filled with interstitial fluid [2][3][4] or cerebrospinal fluid (CSF) [5]. Even more rarely they can become markedly enlarged and therefore symptomatic.…”

“…Even more rarely they can become markedly enlarged and therefore symptomatic. When located in the midbrain, they typically present with a progressive syndrome mimicking either Parkinson-like diseases or brainstem tumors [4], and may be associated with symptoms of obstructive hydrocephalus when the aqueduct is compressed [5][6][7]. Treatment is required in symptomatic cases and, given their particular location, a minimally invasive approach is desirable.…”