PDF(Pubmed)
Abstract：
BACKGROUND: Perivascular spaces (PVSs) are spaces in brain parenchyma filled with interstitial fluid surrounding small cerebral vessels. Massive enlargements of PVSs are referred to as \"giant tumefactive perivascular spaces\" (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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：血管周围空间（PVSs）是脑实质中充满间质液的小脑血管周围的空间。PVSs的大量扩大被称为“巨大的管状血管周围空间”(GTPVSs)，根据它们的本地化可以分为三种类型。这些病变很罕见,主要无症状，通常最初被误解为囊性肿瘤的形成。然而,有报道的几个病例中，GTPVSs由于其大小而引起神经系统症状，质量效应,和位置,最终导致梗阻性脑积水，需要神经外科干预。这里介绍了GTPVS的三种不同的临床表现。
方法：这里，作者观察到一个无症状的1型GTPVS病例和两个有症状的3型GTPVS病例，一个引起局部肿块效应，另一个引起脑积水。
结论：GTPVSs大多为无症状性病变。没有症状的患者应密切监测，活检是不鼓励的。由GTPVS引起的脑积水需要手术干预。在这些情况下,第三脑室造瘘术,分流植入,或直接囊肿开窗术是手术选择。对于出现局部肿块效应症状的患者，对潜在的神经外科干预进行全面评估势在必行.建议在3型GTPVS中跟进，特别是在未经治疗的情况下。鉴于GTPVS的频率不高，神经外科治疗和后续随访的最终指南仍然难以捉摸。
方法：这里，作者观察到一个无症状的1型GTPVS病例和两个有症状的3型GTPVS病例，一个引起局部肿块效应，另一个引起脑积水。
结论：GTPVSs大多为无症状性病变。没有症状的患者应密切监测，活检是不鼓励的。由GTPVS引起的脑积水需要手术干预。在这些情况下,第三脑室造瘘术,分流植入,或直接囊肿开窗术是手术选择。对于出现局部肿块效应症状的患者，对潜在的神经外科干预进行全面评估势在必行.建议在3型GTPVS中跟进，特别是在未经治疗的情况下。鉴于GTPVS的频率不高，神经外科治疗和后续随访的最终指南仍然难以捉摸。
