Posterior fossa giant tumefactive perivascular spaces: 8-year follow-up in an adolescent

Abstract

Background:Cystic masses in the posterior fossa are ominous appearing lesions with broad differential diagnosis. Giant tumefactive perivascular spaces (GTPS) are rarely occurring pathological findings in the posterior fossa with unclear etiology and ill-defined long-term prognosis.Case Description:We present a case of a 15-year-old male diagnosed with posterior fossa GTPS. The patient remained asymptomatic during the 8-year follow-up after diagnosis with the serial magnetic resonance imaging (MRI) showing no change in the size and morphology of the lesion.Conclusion:This case supports prior literature on supratentorial GTPS suggesting that the natural history of GTPS is mostly benign. Identification of GTPS in the posterior fossa could prevent the patient from unnecessary surgery or other aggressive treatment modalities.

Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces

“…Proton MR spectroscopy was performed to characterize giant PVSs in only a few cases in the published literature (20)(21)(22)(23). In two pediatric patients who underwent MR spectroscopy in the literature, MR spectroscopy demonstrated normal metabolite distribution without choline increase and lactate peaks in the cerebral hemispheric and cerebellar giant PVSs (20,21). On the other hand, Mascalchi et al (23) reported proton MR spectroscopy features of two mesencephalic giant PVSs.…”

Tumefactive Virchow-Robin spaces

“…Tumefactive VRs at other locations There were 16 patients (8 females; mean age 45.1 years; age range 6-86 years) with tumefactive VRs at other locations. These locations were the middle cerebellar peduncle and/or pons region (n = 3) [16,29,54], cerebral peduncle, pons, middle cerebellar peduncle, and dentate nucleus (n = 1) [49], dentate nucleus (n = 1) [3], anterior temporal pole (n = 9) [12,21,22,41], hippocampus (n = 1) [72], and widespread locations (left temporal and occipital lobe, bilateral basal ganglia and thalami, along subependymal lining of temporal, occipital horn and body of left lateral and fourth ventricle, left periventricular white matter, left cerebellar hemisphere and vermis) (n-1) [51].…”

“…In 5/ 17 (29.4%) patients, presenting symptoms were attributed to the presence of tumefactive VRs [16,17,22,29,72]. A 15-year-old male patient underwent biopsy of tumefactive VRs in the middle cerebellar peduncle; in the postoperative period, the patient completely recovered from upper gaze palsy and double vision, as well as his left hemiparesis and hemihypesthesia [16]. Follow-up MRI up to 8 years showed no change of the tumefactive VRs [16].…”

“…A 15-year-old male patient underwent biopsy of tumefactive VRs in the middle cerebellar peduncle; in the postoperative period, the patient completely recovered from upper gaze palsy and double vision, as well as his left hemiparesis and hemihypesthesia [16]. Follow-up MRI up to 8 years showed no change of the tumefactive VRs [16]. In a 47-year-old female patient, temporal lobe seizures completely resolved after surgical excision of tumefactive VRs in the anterior temporal pole [22].…”

“…Follow-up MRI after 5 months showed no change of the tumefactive VRs [72]. Hyperintensity of the adjacent brain parenchyma on FLAIR / T2-weighted images was reported to be present in 10 patients [12,16,21,22,51,54].…”