Giant tumefactive perivascular spaces: A further case

Abstract

Virchow-Robin spaces (VRS) or the perivascular spaces are small pial lined, cystic structures in the brain and are filled with interstitial fluid. They are normal spaces, identified in all age groups and are common in places where the penetrating vessels enter into the substance of brain. Occasionally, these spaces can be enlarged and are termed as giant tumefactive perivascular spaces (GTPVS). When enlarged, these cysts are commonly confused with other lesions such as cystic neoplasms. The pathognomonic imaging appearance helps in the diagnosis of this condition in most instances and invasive management is unwarranted. We report a 4-year-old male with GTPVS. In our patient, GTPVS were diagnosed incidentally on brain imaging ordered for a head trauma and he was managed conservatively. During 1-year follow-up, he remained asymptomatic and the size of the cysts was virtually unchanged.

Giant tumefactive perivascular spaces: A case report

“…[ 1 ] These spaces are most commonly found along the lenticulostriate arteries, but can be located anywhere in the brain, including the midbrain, white matter, and thalamus. [ 1 - 3 ]…”

“…When these perivascular spaces enlarge, typically greater than 1.5 cm in size, they are referred to as giant or tumefactive perivascular spaces. [ 3 ] The condition is relatively uncommon, with one retrospective review by Salzman et al . showing only 37 cases from 1988 to 2004.…”

“…[ 1 , 2 ] Once discovered, giant perivascular spaces are left untreated unless complications from their presence arise. [ 3 ] The biggest complication observed is obstructive hydrocephalus secondary to enlargement with associated mass effect. [ 2 , 4 ] The degree of hydrocephalus may become so severe that surgical intervention and intraventricular shunt placement may be indicated.…”

“…Perivascular spaces, also referred to as Virchow–Robin spaces, are interstitial fluid-filled regions that lie deep to the pia mater. [ 1 - 3 ] They follow cerebral arteries and veins as they penetrate the cortex and are considered a normal anatomical structure, hypothesized to function in both a lymphatic and immunological capacity. [ 1 ] However should these spaces enlarge they can exert mass effect, resulting in complications such as obstructive hydrocephalus.…”

A child with giant tumefactive perivascular spaces

“…[1][2][3] Lack of a solid component and complete suppression on FLAIR differentiates them from cystic neoplasms. 1 Nil to minimal peri-lesional FLAIR signals help to differentiate them from cystic infarction and mucopolysaccharidosis.…”