Dilatation of Virchow-Robin Perivascular Spaces: Report of 3 Cases with Different Localizations

Abstract

We report on three different cases with Virchow-Robin spaces, including one with extreme widening causing hydrocephalus. In one patient we have performed neuroendoscopic cyst fenestration to resolve the problem.

Hydrocephalus due to extreme dilation of Virchow-Robin spaces

“…Extreme dilations of VRS are rare. Diverse symptoms have been described, depending on their localisation 2 3. Most frequently, radiological signs of hydrocephalus (with various clinical impacts) have been associated with cystic widening of VRS.…”

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

“…Cyst wall biopsy was compatible with enlarged PVSs. Caner also described the case of a patient successfully treated by endoscopic fenestration of the cyst wall [5]. Although this pathology typically occurs in elderly people, Fayeye et al recently reported the case of a 6-year-old boy with "mesencephalic enlarged Virchow-Robin spaces", successfully treated with endoscopic cyst-ventriculostomy [13].…”

“…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].…”

“…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.…”

“…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.…”