Hydrocephalus due to dilation of Virchow-Robin spaces
DOI:
https://doi.org/10.59156/revista.v38i03.655Keywords:
Endoscopic third ventriculostomy, Hydrocephalus, Ventriculoperitoneal shunt, Virchow-Robin spacesAbstract
Background: Virchow-Robin spaces (VRS) are dilations of perivascular spaces that contain cerebrospinal fluid (CSF) and, sometimes, can cause hydrocephalus.
Objectives: to communicate an infrequent case involving a patient afflicted with obstructive hydrocephalus due to dilation of Virchow-Robin spaces.
Case description: a 51-year-old female exhibited symptoms of urinary and fecal incontinence, gait disturbances, and cognitive decline over the course of one year. Brain magnetic resonance imaging (MRI) revealed a midbrain multicystic lesion spanning from both thalamus to the pons, T1 and FLAIR hypointense, T2 hyperintense. No enhancement was detected after contrast injection consistent with Virchow-Robin spaces dilation exerting pressure on the Sylvius aqueduct and causing hydrocephalus.
Surgery: a ventricular-peritoneal (VP) shunt was implanted resulting in symptom remission. However, shunt revision had to be performed in two occasions with device removal. An endoscopic third ventriculostomy (EVT) was then carried out observing VRS imprint on posterior thalamus and third ventricle floor with Liliequist membrane already fenestrated. Finally, a new contralateral VP shunt was inserted with favorable clinical outcome.
Conclusions: dilation of Virchow-Robin spaces may mimic other pathologies with a different prognosis and treatment. When symptomatic, the most effective treatment is CSF diversion either by VP shunt or EVT dependent on the anatomical configuration of third ventricle floor.
Downloads
References
Fayeye O, Pettorini BL, Foster K, Rodrigues D. Mesencephalic enlarged Virchow-Robin spaces in a 6-year-old boy: a case-based update. Childs Nerv Syst, 2010; 26(9): 1155-60.
Kim DG, Oh SH, Kim OJ. A case of disseminated polycystic dilated perivascular spaces presenting with dementia and Parkinsonism. J Clin Neurol, 2007; 3(2): 96-100.
House P, Salzman KL, Osborn AG, y cols. Surgical considerations regarding giant dilations of perivascular spaces. J Neurosurg, 2004; 100(5): 820-4.
Revel F, Cotton F, Haine M, Gilbert T. Hydrocephalus due to extreme dilation of Virchow-Robin spaces. BMJ Case Rep, 2015; 2015: bcr2014207109.
Woo PY, Cheung E, Zhuang JT, Wong HT, Chan KY. A giant tumefactive perivascular space: A rare cause of obstructive hydrocephalus and monoparesis. Asian J Neurosurg, 2018; 13(4): 1295-300.
Ottenhausen M, Meier U, Tittel A, Lemcke J. Acute decompensation of noncommunicating hydrocephalus caused by dilated Virchow-Robin spaces type III in a woman treated by endoscopic third ventriculostomy: a case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg, 2013; 74 (Suppl 1): e242-7.
Yu L, Hu X, Li H and Zhao Y. Perivascular spaces, glymphatic system and MR. Front Neurol, 2022; 13: 844938.
Ahmad FU, Garg A, Singh M, Mishra NK. Giant mesencephalic Virchow-Robin spaces causing obstructive hydrocephalus. Neuroradiol J, 2007; 20(3): 303-6.
Lo YT, Kirollos RW, Chen MW, Cheong TM, Keong NCH. Aqueductal compression by dilated Virchow-Robin spaces in the mesencephalic-pontine region presenting with symptoms mimicking normal pressure hydrocephalus: A case report and review of literature. World Neurosurg, 2020; 138: 390-7.
Kumar A, Gupta R, Garg A, Sharma BS. Giant mesencephalic dilated Virchow-Robin spaces causing obstructive hydrocephalus treated by endoscopic third ventriculostomy. World Neurosurg, 2015; 84(6): 2074.e11-4.
Caner B, Bekar A, Hakyemez B, Taskapilioglu O, Aksoy K. Dilatation of Virchow-Robin perivascular spaces: report of 3 cases with different localizations. Minim Invasive Neurosurg, 2008; 51(1): 11-4.
Papayannis CE, Saidon P, Rugilo CA, y cols. Expanding Virchow-Robin spaces in the midbrain causing hydrocephalus. AJNR Am J Neuroradiol, 2003; 24(7): 1399-403.
Sturiale CL, Albanese A, Lofrese G, y cols. Pathological enlargement of midbrain Virchow-Robin spaces: a rare cause of obstructive hydrocephalus. British J Neurosurg, 2011; 25(1): 130-1.
Song CJ, Kim JH, Kier EL, y cols. MR imaging and histologic features of subinsular bright spots on T2-weighted MR images: Virchow-Robin spaces of the extreme capsule and insular cortex. Radiology, 2000; 214(3): 671-7.
Heier LA, Bauer CJ. Schwartz L, Zimmerman RD, Morgello. Deck MD. Large Virchow-Robin spaces: MR-Clinical correlation. ANJR Am J Neuroradiol, 1989; 10(5): 929-36.
