Giant Tumefactive Mesencephalothalamic Virchow-Robin Space with Triventricular Hydrocephalus: a Case-Based Systematic Literature Review
Child's Nervous System（2024）
Abstract
The perivascular spaces of the brain are also known as Virchow-Robin spaces (VRSs). Dilated Virchow-Robin spaces in the brainstem are rare and mainly cause symptoms due to obstructive hydrocephalus, less frequently because of their size, mass effect, and impact on eloquent structures. We present a patient with giant tumefactive VRS with hydrocephalus and neurological symptoms who was treated with endoscopic third ventriculostomy (ETV) followed by microscopic cyst fenestration. On the basis of this observation, we performed a thorough review of the literature to evaluate different treatment options. An 11-year-old girl presented with a headache for 3 months. The patient had a giant tumefactive mesencephalothalamic VRS with triventricular hydrocephalus. She was initially treated with endoscopic third ventriculostomy and multiple cyst fenestration. Symptomatic cyst regrowth required multiple cyst fenestrations via transcallosal transchoroidal (N = 2) and subtemporal approaches (N = 1) at the 2- and 4-year follow-ups. A literature review of these conditions allowed the detection of 12 cases (including our index case), and only 25
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Key words
Virchow-Robin spaces,Dilated Virchow-Robin spaces,Tumefactive perivascular spaces,Hydrocephalus,Aqueductal stenosis,Endoscopic third ventriculostomy,Subtemporal approach,Transchoroidal approach
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