Child's Nervous System

, Volume 26, Issue 9, pp 1155–1160 | Cite as

Mesencephalic enlarged Virchow–Robin spaces in a 6-year-old boy: a case-based update

  • Oluwafikayo Fayeye
  • Benedetta Ludovica Pettorini
  • Katharine Foster
  • Desiderio Rodrigues
Case-Based Update

Abstract

Background

Perivascular spaces or Virchow–Robin spaces are normal anatomical structures within the brain, typically less than 5 mm in diameter. Rarely, they can reach much larger sizes and adopt bizarre single or multi-cystic configurations, as was the case in the patient that we report on. When there is such markedly gross dilatation, the phenomenon is known as Giant or tumefactive perivascular space enlargement.

Case report

We report a 6-year-old boy with a multi-cystic mesencephalic lesions presenting with obstructive hydrocephalus secondary to obstruction of the aqueduct of Sylvius due to tumefactive dilatation of Virchow–Robin spaces. The patient underwent an endoscopic fenestration and biopsy of the cystic portion abutting into the ventricular system.

Conclusion

In this paper, we discuss the phenomenon of perivascular (Virchow–Robin) spaces and their treatment options and review the relevant literature. To our knowledge, this is the first pediatric case of tumefactive dilatation of the Virchow–Robin spaces causing obstructive hydrocephalus that were directly fenestrated using neuroendoscopy.

Keywords

Giant perivascular space enlargement Mesencephalon Endoscopic fenestration Intraventricular cyst 

References

  1. 1.
    Artigas J, Poo P, Rovira A, Cardo E (1999) Macrocephaly and dilated Virchow–Robin spaces in childhood. Pediatr Radiol 29(3):188–190CrossRefPubMedGoogle Scholar
  2. 2.
    Barkhof F (2004) Enlarged Virchow–Robin spaces: do they matter? J Neurol Neurosurg Psychiatry 75:1516–1517CrossRefPubMedGoogle Scholar
  3. 3.
    Benhaiem-Sigaux N, Gray F, Gherardi R, Roucayrol AM, Poirier J (1987) Expanding cerebellar lacunae due to dilatation of the perivascular space associated with Binswanger’s subcortical arteriosclerotic encephalopathy. Stroke 18:1087–1092PubMedGoogle Scholar
  4. 4.
    Bruna AL, Martins I, Husson B, Landrieu P (2009) Developmental dilatation of Virchow–Robin spaces: a genetic disorder? Pediatr Neurol 41(4):275–280CrossRefPubMedGoogle Scholar
  5. 5.
    Demaerel P, Wilms G, Baert AL (1996) Widening of Virchow–Robin spaces [letter]. AJNR Am J Neuroradiol 17:800–801PubMedGoogle Scholar
  6. 6.
    Derouesne C, Gray F, Escourolle R, Castaigne P (1987) ‘Expanding cerebral lacunae’ in a hypertensive patient with normal pressure hydrocephalus. Neuropathol Appl Neurobiol 13:309–320CrossRefPubMedGoogle Scholar
  7. 7.
    Gordon M, Parmar H, Ibrahim M (2009) Spread of infection to Virchow–Robin spaces in a patient with streptococcus pneumoniae meningitis. J Comput Assist Tomogr 33(4):562–564CrossRefPubMedGoogle Scholar
  8. 8.
    Groeschel S, Brockmann K, Dechent P, Wilichowski E, Frahm J, Hanefeld F (2006) Magnetic resonance imaging and proton magnetic resonance spectroscopy of megalencephaly and dilated Virchow–Robin spaces. Pediatr Neurol 34(1):35–40CrossRefPubMedGoogle Scholar
  9. 9.
    Heier LA, Bauer CJ, Schwartz L, Zimmerman RD, Morgello S, Deck MD (1989) Large Virchow–Robin spaces: MR-clinical correlation. AJNR Am J Neuroradiol 10:929–936PubMedGoogle Scholar
  10. 10.
    Homeyer P, Cornu P, Lacomblez L, Chiras J, Derouesne C (1996) A special form of cerebral lacunae: expanding lacunae. J Neurol Neurosurg Psychiatry 61:200–202CrossRefPubMedGoogle Scholar
  11. 11.
    House P, Salzman KL, Osborn AG, MacDonald JD, Jensen RL, Couldwell WT (2004) Surgical considerations regarding giant dilations of the perivascular spaces. J Neurosurg 100:820–824CrossRefPubMedGoogle Scholar
  12. 12.
    Jungreis CA, Kanal E, Hirsch WL, Martinez AJ, Moossy J (1988) Normal perivascular spaces mimicking lacunar infarction: MR imaging. Radiology 169:101–102PubMedGoogle Scholar
  13. 13.
    Kim DG, Oh SH, Kim OJ (2007) A case of disseminated polycystic dilated perivascular spaces presenting with dementia and Parkinsonism. J Clin Neurol 3(2):96–100CrossRefPubMedGoogle Scholar
  14. 14.
    Longatti PL, Fiorindi A, Carteri A, Caroli F, Martinuzzi A (2003) Expanding cerebral cysts (lacunae): a treatable cause of progressive midbrain syndrome. J Neurol Neurosurg Psychiatry 74:393–394CrossRefPubMedGoogle Scholar
  15. 15.
    Maclullich AM, Wardlaw JM, Ferguson KJ, Starr JM, Seckl JR, Deary IJ (2004) Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry 75:1519–1523CrossRefPubMedGoogle Scholar
  16. 16.
    Morisako H, Tuyuguchi H, Nagata T, Chokyu I, Ichinose T, Ishibashi K, Ohata K (2009) Enlarged perivascular spaces associated with hydrocephalus: a case report. No Shinkei Geka 37(7):681–686PubMedGoogle Scholar
  17. 17.
    Ogawa R, Okudera T, Fukasawa H, Hashimoto M, Inugami A, Fujita H, Hatazawa J, Shimosegawa E, Noguchi K, Uemura K (1995) Unusual widening of Virchow–Robin spaces: MR appearance. AJNR Am J Neuroradiol 16:1238–1242PubMedGoogle Scholar
  18. 18.
    Patankar TF, Mitra D, Varma A, Snowden J, Neary D, Jackson A (2005) Dilation of the Virchow–Robin space is a sensitive indicator of cerebral microvascular disease: study in elderly patients with dementia. AJNR Am J Neuroradiol 26:1512–1520PubMedGoogle Scholar
  19. 19.
    Poirier J, Barbizet J, Gaston A, Meyrignac C (1983) Thalamic dementia. Expansive lacunae of the thalamo-paramedian mesencephalic area. Hydrocephalus caused by stenosis of the aqueduct of Sylvius. Rev Neurol (Paris) 139:349–358Google Scholar
  20. 20.
    Roher AE, Kuo YM, Esh C, Knebel C, Weiss N, Kalback W, Luehrs DC, Childress JL, Beach TG, Weller RO, Kokjohn TA (2003) Cortical and leptomeningeal cerebro-vascular amyloid and white matter pathology in Alzheimer’s disease. Mol Med 9:112–122PubMedGoogle Scholar
  21. 21.
    Rohlfs J, Riegel T, Khalil M, Iwinska-Zelder J, Mennel HD, Bertalanffy H, Hellwig D (2005) Enlarged perivascular spaces mimicking multicystic brain tumours. Report of two cases and review of the literature. J Neurosurg 102(6):1142–1146CrossRefPubMedGoogle Scholar
  22. 22.
    Salzman KL, Osborn AG, Hause P, Jinkins JR, Ditchfield A, Copper JA, Weller RO (2005) Giant tumefactive perivascular spaces. Am J Neuroradiol 26:298–305PubMedGoogle Scholar
  23. 23.
    Staines DR, Brenu EW, Marshall-Gradisnik S (2008) Postulated role of vasoactive neuropeptide related immunopathology of the blood brain barrier and Virchow–Robin spaces in the aetiology of neurological related conditions. Mediators Inflamm 2008:792428CrossRefPubMedGoogle Scholar
  24. 24.
    Ugawa Y, Shirouzu I, Terao Y, Hanajima R, Machii K, Mochizuki H, Furubayashi T, Kanazawa I (1998) Physiological analyses of a patient with extreme widening of Virchow–Robin spaces. J Neurol Sci 159:25–27CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Oluwafikayo Fayeye
    • 1
  • Benedetta Ludovica Pettorini
    • 1
  • Katharine Foster
    • 2
  • Desiderio Rodrigues
    • 1
  1. 1.Paediatric Neurosurgery DepartmentBirmingham Children’s HospitalBirminghamUK
  2. 2.Radiology DepartmentBirmingham Children’s HospitalBirminghamUK

Personalised recommendations