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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(04): 311-316
DOI: 10.1055/s-0040-1716562
Case Report | Relato de Caso

Atypical Virchow-Robin Spaces Mimicking Cystic Primary Brain Tumor – Clinical Report and Literature Review

Espaços perivasculares atípicos de Virchow-Robin simulando neoplasia primária do sistema nervoso central – Série de casos e revisão de literatura
Helder Picarelli 
1   Division of Neurosurgery, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
,
Thales Bhering Nepomuceno 
2   Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Yuri Casal 
3   Division of Anatomical Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Vitor Nagai Yamaki 
2   Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira 
2   Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo 
2   Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract

The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT and MRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).

Resumo

Os espaços perivasculares alargados de Virchow-Robin (EVRs), que são frequentemente observados incidentalmente nos modernos exames estruturais de neuroimagem como pequenas cavidades císticas, geralmente circundam as pequenas artérias e arteríolas ao nível dos gânglios da base, da substância perfurada anterior e da junção tálamo-mesencefálica. Normalmente, eles têm características físico-químicas semelhantes às do líquido cefalorraquidiano e não apresentam realce após a injeção de contraste iodado ou paramagnético nas imagens obtidas por tomografia ou ressonância magnética de crânio. O significado real desse achado é desconhecido, embora alguns estudos contemporâneos tenham sugerido que eles possam estar relacionados a certas lesões cerebrais traumáticas ou a vários outros distúrbios do sistema nervoso central (CNS), como algumas doenças degenerativas. Ocasionalmente, alguns EVRs volumosos e atípicos podem ser confundidos com tumores cerebrais primários císticos, especialmente no contexto de lesões grandes e sintomáticas, cistos agrupados múltiplos, lesões corticais e se houver gliose reativa adjacente. O presente artigo relata quatro pacientes portadores de EVR atípicos, mimetizando tumores cerebrais, que necessitaram de acompanhamento com imagens seriadas ou até uma biópsia para confirmar o diagnóstico ou indicar o tratamento adequado. Embora não seja tão incomum, um deles ocorreu concomitantemente e adjacente a um glioma difuso (co-deletado 1p19q, OMS-GII).

Keywords

virchow-robin space - enlarged perivascular space - atypical virchow-robin space - cystic brain tumor

Palavras-chave

espaço de Virchow-Robin - espaço perivascular aumentado - espaço de Virchow-Robin atípico - tumor cerebral cístico


Publication History

Received: 19 February 2020

Accepted: 07 July 2020

Article published online:
30 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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