Endoscopic infratentorial supracerebellar approach for the mesencephalic enlarged Virchow Robin space fenestration, an alternative minimally invasive route

Khoulali, Mohamed; Mehfoud, Ibrahim; Mejdoubi, Anasse; Khay, Hamid; Guini, Mohammed; Oulali, Noureddine; Moufid, Fayçal; Mebrouk, Yassine; Bkyer, Houssam; Housni, Brahim

doi:10.1016/j.inat.2022.101715

Cited by 1 publication

(1 citation statement)

References 14 publications

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“…To our knowledge, roughly 170 GTPVS cases have been documented in the literature. [5][6][7][9][10][11][12][13] GTPVSs are characterized as dilated PVSs exceeding 15 mm in width. They predominantly arise in the mesencephalic region near the lenticulostriate arteries or penetrate the cerebral cortex, but they can also be found in areas such as the subinsular region, dentate nuclei, or cerebellum.…”

Section: Observationsmentioning

confidence: 99%

Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases

Neyazi,

Swiatek,

Stein

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Perivascular spaces (PVSs) are spaces in brain parenchyma filled with interstitial fluid surrounding small cerebral vessels. Massive enlargements of PVSs are referred to as “giant tumefactive perivascular spaces” (GTPVSs), which can be classified into three types depending on their localization. These lesions are rare, predominantly asymptomatic, and often initially misinterpreted as cystic tumor formations. However, there are several reported cases in which GTPVSs have induced neurological symptoms because of their size, mass effect, and location, ultimately leading to obstructive hydrocephalus necessitating neurosurgical intervention. Presented here are three diverse clinical presentations of GTPVS. OBSERVATIONS Here, the authors observed an asymptomatic case of type 1 GTPVS and two symptomatic cases of type 3 GTPVS, one causing local mass effect and the other hydrocephalus. LESSONS GTPVSs are mostly asymptomatic lesions. Patients without symptoms should be closely monitored, and biopsy is discouraged. Hydrocephalus resulting from GTPVS necessitates surgical intervention. In these cases, third ventriculostomy, shunt implantation, or direct cyst fenestration are surgical options. For patients presenting with symptoms from localized mass effect, a thorough evaluation for potential neurosurgical intervention is imperative. Follow-up in type 3 GTPVS is recommended, particularly in untreated cases. Given the infrequency of GTPVS, definitive guidelines for neurosurgical treatment and subsequent follow-up remain elusive.

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