gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Enlarged perivascular spaces mimicking multicystic brain tumors. Report of two cases treated by neuroendoscopy

Erweiterte Virchow-Robin-Räume – Differentialdiagnose bei multizystischen Hirntumoren. Vorstellung zweier neuroendoskopisch therapierter Patienten

Meeting Abstract

  • corresponding author J. Rohlfs - Klinik für Neurochirurgie, Klinikum der Philipps-Universität Marburg
  • T. Riegel - Klinik für Neurochirurgie, Klinikum der Philipps-Universität Marburg
  • J. Iwinska-Zelder - Abtl. für Neuroradiologie, Klinikum der Philipps-Universität Marburg
  • H.D. Mennel - Abtl. für Neuropathologie, Klinikum der Philipps-Universität Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Klinikum der Philipps-Universität Marburg
  • D. Hellwig - Klinik für Neurochirurgie, Klinikum der Philipps-Universität Marburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 01.3

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Rohlfs et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Enlarged perivascular spaces are extensions of the pia mater accompanying perforating arteries and containing interstitial fluid. These spaces can also invade the peri- and supraventricular white matter and occasionally mimic cystic tumors, infectious disease, mucopolysaccharidosis and multiple sclerosis. Prominent perivascular spaces (PVSs) may cause focal neurological symptoms and can lead to extended space occupying effects with a consecutive three-ventricular hydrocephalus. In these symptomatic cases neurosurgical intervention is required.

Methods: We report on two cases of expanding and symptomatic prominent perivascular spaces. One patient suffered from headache and vertigo, the other individual showed headache and tremor. Neuroendoscopical intervention was performed to obtain biopsies for histopathological diagnosis and to reduce the space occupying effect.

Results: Both patients were successfully treated by neuroendoscopic intervention. The space occupying cystic lesions were fenestrated by endoscopic cysto-cisternostomy respectively ventriculo-cystostomy. In the 2-years follow-up, both individuals showed a complete resolution of their preoperative neurological symptoms. The radiological findings were declining with cystic remnants.

Conclusions: The neuroendoscopical approach including cysto-cisternostomy or ventriculo-cystostomy seems to be an effective treatment option of enlarged perivascular spaces with compressive effect on adjacent brain tissue and consecutive hydrocephalus. In our two cases the use of neuroendoscopical techniques minimized the operative risk, verifies histopathological diagnosis and led to an excellent clinical outcome.