{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:43:20Z","timestamp":1770353000950,"version":"3.49.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Perivascular spaces (PVSs) are spaces in brain parenchyma filled with interstitial fluid surrounding small cerebral vessels. Massive enlargements of PVSs are referred to as \u201cgiant tumefactive perivascular spaces\u201d (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23564","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T18:58:44Z","timestamp":1708973924000},"source":"Crossref","is-referenced-by-count":2,"title":["Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases"],"prefix":"10.3171","volume":"7","author":[{"given":"Belal","family":"Neyazi","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa Magdalena","family":"Swiatek","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus-Peter","family":"Stein","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Rashidi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seraphine","family":"Zubel","sequence":"additional","affiliation":[{"name":"Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony-Anhalt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Amini","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I. Erol","family":"Sandalcioglu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Lancet Neurol","first-page":"822","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw JM","year":"2013","unstructured":"Wardlaw JM, Smith EE, Biessels GJ,  Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822\u2013838."},{"issue":"3","key":"b2","series-title":"AJR Am J Roentgenol","first-page":"551","article-title":"Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces","volume":"151","author":"Braffman BH","year":"1988","unstructured":"Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces. AJR Am J Roentgenol. 1988;151(3):551\u2013558."},{"issue":"2","key":"b3","series-title":"J Anat","first-page":"193","article-title":"The perivascular spaces of the mammalian central nervous system and their relation to the perineuronal and subarachnoid spaces","volume":"89","author":"Woollam DH","year":"1955","unstructured":"Woollam DH, Millen JW The perivascular spaces of the mammalian central nervous system and their relation to the perineuronal and subarachnoid spaces. J Anat. 1955;89(2):193\u2013200."},{"issue":"11","key":"b4","series-title":"Stroke","first-page":"2483","article-title":"Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study","volume":"41","author":"Zhu YC","year":"2010","unstructured":"Zhu YC, Tzourio C, Soumar\u00e9 A, Mazoyer B, Dufouil C, Chabriat H Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study. Stroke. 2010;41(11):2483\u20132490."},{"key":"b5","series-title":"World Neurosurg","first-page":"201","article-title":"Giant tumefactive perivascular spaces: a case report and literature review","volume":"112","author":"Al Abdulsalam H","year":"2018","unstructured":"Al Abdulsalam H, Alatar AA, Elwatidy S Giant tumefactive perivascular spaces: a case report and literature review. World Neurosurg. 2018;112:201\u2013204."},{"issue":"4","key":"b6","series-title":"Asian J Neurosurg","first-page":"1295","article-title":"A giant tumefactive perivascular space: a rare cause of obstructive hydrocephalus and monoparesis","volume":"13","author":"Woo PY","year":"2018","unstructured":"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\u20131300."},{"key":"b7","series-title":"Eur J Radiol","first-page":"21","article-title":"Tumefactive Virchow-Robin spaces","volume":"111","author":"Kwee RM","year":"2019","unstructured":"Kwee RM, Kwee TC Tumefactive Virchow-Robin spaces. Eur J Radiol. 2019;111:21\u201333."},{"issue":"4","key":"b8","series-title":"Radiographics","first-page":"1071","article-title":"Virchow-Robin spaces at MR imaging","volume":"27","author":"Kwee RM","year":"2007","unstructured":"Kwee RM, Kwee TC Virchow-Robin spaces at MR imaging. Radiographics. 2007;27(4):1071\u20131086."},{"issue":"2","key":"b9","series-title":"AJNR Am J Neuroradiol","first-page":"298","article-title":"Giant tumefactive perivascular spaces","volume":"26","author":"Salzman KL","year":"2005","unstructured":"Salzman KL, Osborn AG, House P,  Giant tumefactive perivascular spaces. AJNR Am J Neuroradiol. 2005;26(2):298\u2013305."},{"key":"b10","series-title":"Surg Neurol Int","first-page":"191","article-title":"Giant tumefactive perivascular spaces: a case report","volume":"11","author":"Freeman K","year":"2020","unstructured":"Freeman K, Hays R, Kouri J Giant tumefactive perivascular spaces: a case report. 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Radiology. 2000;214(3):671\u2013677."},{"issue":"1","key":"b15","series-title":"Can J Neurol Sci","first-page":"5","article-title":"Perivascular spaces: normal and giant","volume":"34","author":"Fanous R","year":"2007","unstructured":"Fanous R, Midia M Perivascular spaces: normal and giant. Can J Neurol Sci. 2007;34(1):5\u201310."},{"issue":"1","key":"b16","series-title":"J Neuroophthalmol","first-page":"75","article-title":"A giant tumefactive Virchow-Robin space: a rare cause of a homonymous quadrantanopia","volume":"37","author":"Rivet A","year":"2017","unstructured":"Rivet A, Gauthier AS, Chatain M, Billon-Grand R, Thines L, Delbosc B A giant tumefactive Virchow-Robin space: a rare cause of a homonymous quadrantanopia. J Neuroophthalmol. 2017;37(1):75\u201376."},{"issue":"1","key":"b17","series-title":"Minim Invasive Neurosurg","first-page":"11","article-title":"Dilatation of Virchow-Robin perivascular spaces: report of 3 cases with different localizations","volume":"51","author":"Caner B","year":"2008","unstructured":"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\u201314."},{"issue":"4","key":"b18","series-title":"Br J Neurosurg","first-page":"549","article-title":"Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: therapeutic and pathomechanical considerations","volume":"29","author":"Zafar N","year":"2015","unstructured":"Zafar N, Alaid A, Rohde V, Mielke D Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: therapeutic and pathomechanical considerations. Br J Neurosurg. 2015;29(4):549\u2013551."},{"issue":"6","key":"b19","series-title":"Neurol India","first-page":"709","article-title":"Virchow-Robin spaces producing visual field defect","volume":"62","author":"Matalia JH","year":"2014","unstructured":"Matalia JH, Rajput VK, Shetty BK Virchow-Robin spaces producing visual field defect. Neurol India. 2014;62(6):709\u2013711."},{"issue":"2","key":"b20","series-title":"J Neurol Neurosurg Psychiatry","first-page":"200","article-title":"A special form of cerebral lacunae: expanding lacunae","volume":"61","author":"Homeyer P","year":"1996","unstructured":"Homeyer P, Cornu P, Lacomblez L, Chiras J, Derouesn\u00e9 C A special form of cerebral lacunae: expanding lacunae. J Neurol Neurosurg Psychiatry. 1996;61(2):200\u2013202."},{"issue":"6","key":"b21","series-title":"Med Arh","first-page":"386","article-title":"Intraparenchimal mesencephalic cyst: an unusual location","volume":"60","author":"Brkic H","year":"2006","unstructured":"Brkic H, Kehrly P, Jakupovic S, Zornic M Intraparenchimal mesencephalic cyst: an unusual location. Med Arh. 2006;60(6):386\u2013388."},{"issue":"3","key":"b22","series-title":"Clin Neuropathol","first-page":"183","article-title":"Ependymal cyst of the midbrain","volume":"32","author":"Prieto R","year":"2013","unstructured":"Prieto R, Subhi-Issa I, Pascual JM Ependymal cyst of the midbrain. Clin Neuropathol. 2013;32(3):183\u2013188."},{"issue":"8","key":"b1","series-title":"Lancet Neurol","first-page":"822","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw JM","year":"2013","unstructured":"Wardlaw JM, Smith EE, Biessels GJ,  Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822\u2013838."},{"issue":"3","key":"b2","series-title":"AJR Am J Roentgenol","first-page":"551","article-title":"Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces","volume":"151","author":"Braffman BH","year":"1988","unstructured":"Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces. AJR Am J Roentgenol. 1988;151(3):551\u2013558."},{"issue":"2","key":"b3","series-title":"J Anat","first-page":"193","article-title":"The perivascular spaces of the mammalian central nervous system and their relation to the perineuronal and subarachnoid spaces","volume":"89","author":"Woollam DH","year":"1955","unstructured":"Woollam DH, Millen JW The perivascular spaces of the mammalian central nervous system and their relation to the perineuronal and subarachnoid spaces. J Anat. 1955;89(2):193\u2013200."},{"issue":"11","key":"b4","series-title":"Stroke","first-page":"2483","article-title":"Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study","volume":"41","author":"Zhu YC","year":"2010","unstructured":"Zhu YC, Tzourio C, Soumar\u00e9 A, Mazoyer B, Dufouil C, Chabriat H Severity of dilated Virchow-Robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study. Stroke. 2010;41(11):2483\u20132490."},{"key":"b5","series-title":"World Neurosurg","first-page":"201","article-title":"Giant tumefactive perivascular spaces: a case report and literature review","volume":"112","author":"Al Abdulsalam H","year":"2018","unstructured":"Al Abdulsalam H, Alatar AA, Elwatidy S Giant tumefactive perivascular spaces: a case report and literature review. World Neurosurg. 2018;112:201\u2013204."},{"issue":"4","key":"b6","series-title":"Asian J Neurosurg","first-page":"1295","article-title":"A giant tumefactive perivascular space: a rare cause of obstructive hydrocephalus and monoparesis","volume":"13","author":"Woo PY","year":"2018","unstructured":"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\u20131300."},{"key":"b7","series-title":"Eur J Radiol","first-page":"21","article-title":"Tumefactive Virchow-Robin spaces","volume":"111","author":"Kwee RM","year":"2019","unstructured":"Kwee RM, Kwee TC Tumefactive Virchow-Robin spaces. Eur J Radiol. 2019;111:21\u201333."},{"issue":"4","key":"b8","series-title":"Radiographics","first-page":"1071","article-title":"Virchow-Robin spaces at MR imaging","volume":"27","author":"Kwee RM","year":"2007","unstructured":"Kwee RM, Kwee TC Virchow-Robin spaces at MR imaging. Radiographics. 2007;27(4):1071\u20131086."},{"issue":"2","key":"b9","series-title":"AJNR Am J Neuroradiol","first-page":"298","article-title":"Giant tumefactive perivascular spaces","volume":"26","author":"Salzman KL","year":"2005","unstructured":"Salzman KL, Osborn AG, House P,  Giant tumefactive perivascular spaces. AJNR Am J Neuroradiol. 2005;26(2):298\u2013305."},{"key":"b10","series-title":"Surg Neurol Int","first-page":"191","article-title":"Giant tumefactive perivascular spaces: a case report","volume":"11","author":"Freeman K","year":"2020","unstructured":"Freeman K, Hays R, Kouri J Giant tumefactive perivascular spaces: a case report. Surg Neurol Int. 2020;11:191."},{"issue":"2","key":"b11","series-title":"J Pediatr Neurosci","first-page":"108","article-title":"Giant tumefactive perivascular spaces: a further case","volume":"8","author":"Sankararaman S","year":"2013","unstructured":"Sankararaman S, Velayuthan S, Ambekar S, Gonzalez-Toledo E Giant tumefactive perivascular spaces: a further case. J Pediatr Neurosci. 2013;8(2):108\u2013110."},{"key":"b12","series-title":"Interdiscip Neurosurg","first-page":"101715","article-title":"Endoscopic infratentorial supracerebellar approach for the mesencephalic enlarged Virchow Robin space fenestration, an alternative minimally invasive route","volume":"32","author":"Khoulali M","year":"2023","unstructured":"Khoulali M, Mehfoud I, Mejdoubi A,  Endoscopic infratentorial supracerebellar approach for the mesencephalic enlarged Virchow Robin space fenestration, an alternative minimally invasive route. Interdiscip Neurosurg. 2023;32:101715."},{"issue":"3","key":"b13","series-title":"Br J Neurosurg","first-page":"307","article-title":"Dilated Virchow Robin spaces in brainstem","volume":"37","author":"Sadashiva N","year":"2023","unstructured":"Sadashiva N, Saini J Dilated Virchow Robin spaces in brainstem. Br J Neurosurg. 2023;37(3):307\u2013308."},{"issue":"3","key":"b14","series-title":"Radiology","first-page":"671","article-title":"MR imaging and histologic features of subinsular bright spots on T2-weighted MR images: Virchow-Robin spaces of the extreme capsule and insular cortex","volume":"214","author":"Song CJ","year":"2000","unstructured":"Song CJ, Kim JH, Kier EL, Bronen RA 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\u2013677."},{"issue":"1","key":"b15","series-title":"Can J Neurol Sci","first-page":"5","article-title":"Perivascular spaces: normal and giant","volume":"34","author":"Fanous R","year":"2007","unstructured":"Fanous R, Midia M Perivascular spaces: normal and giant. Can J Neurol Sci. 2007;34(1):5\u201310."},{"issue":"1","key":"b16","series-title":"J Neuroophthalmol","first-page":"75","article-title":"A giant tumefactive Virchow-Robin space: a rare cause of a homonymous quadrantanopia","volume":"37","author":"Rivet A","year":"2017","unstructured":"Rivet A, Gauthier AS, Chatain M, Billon-Grand R, Thines L, Delbosc B A giant tumefactive Virchow-Robin space: a rare cause of a homonymous quadrantanopia. J Neuroophthalmol. 2017;37(1):75\u201376."},{"issue":"1","key":"b17","series-title":"Minim Invasive Neurosurg","first-page":"11","article-title":"Dilatation of Virchow-Robin perivascular spaces: report of 3 cases with different localizations","volume":"51","author":"Caner B","year":"2008","unstructured":"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\u201314."},{"issue":"4","key":"b18","series-title":"Br J Neurosurg","first-page":"549","article-title":"Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: therapeutic and pathomechanical considerations","volume":"29","author":"Zafar N","year":"2015","unstructured":"Zafar N, Alaid A, Rohde V, Mielke D Intermittent visual field defects caused by a dilated Virchow-Robin space close to the optic radiation: therapeutic and pathomechanical considerations. Br J Neurosurg. 2015;29(4):549\u2013551."},{"issue":"6","key":"b19","series-title":"Neurol India","first-page":"709","article-title":"Virchow-Robin spaces producing visual field defect","volume":"62","author":"Matalia JH","year":"2014","unstructured":"Matalia JH, Rajput VK, Shetty BK Virchow-Robin spaces producing visual field defect. Neurol India. 2014;62(6):709\u2013711."},{"issue":"2","key":"b20","series-title":"J Neurol Neurosurg Psychiatry","first-page":"200","article-title":"A special form of cerebral lacunae: expanding lacunae","volume":"61","author":"Homeyer P","year":"1996","unstructured":"Homeyer P, Cornu P, Lacomblez L, Chiras J, Derouesn\u00e9 C A special form of cerebral lacunae: expanding lacunae. J Neurol Neurosurg Psychiatry. 1996;61(2):200\u2013202."},{"issue":"6","key":"b21","series-title":"Med Arh","first-page":"386","article-title":"Intraparenchimal mesencephalic cyst: an unusual location","volume":"60","author":"Brkic H","year":"2006","unstructured":"Brkic H, Kehrly P, Jakupovic S, Zornic M Intraparenchimal mesencephalic cyst: an unusual location. 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