Tumefactive Virchow-Robin spaces

Objective: To systematically review the clinical manifestations, MRI appearance, and management of tumefactive Virchow-Robin spaces (VRs).

Methods: A systematic MEDLINE literature search was performed. Data were extracted per tumefactive VRs location (type 1: along lenticulostriate arteries entering the basal ganglia; type 2: along perforating medullary arteries; type 3: mesencephalothalamic region; and other locations).

Results: Ninety-nine articles were included, comprising 164 patients. There were few reports on type 1 tumefactive VRs (n = 5 patients) and tumefactive VRs at other locations (n = 16 patients). In type 2 tumefactive VRs (n = 62 patients), clinical manifestations were reported in 12.9%, signal abnormalities of adjacent brain parenchyma were reported in 32.3%, and MRI follow-up of 23/24 asymptomatic tumefactive VRs showed no change (mean follow-up of 3.2 years). In type 3 tumefactive VRs (n = 80 patients), clinical manifestations were reported in 75.0%, signal abnormalities inside VRs or adjacent brain parenchyma were reported in 3.8%, and neurosurgical outcome (59 reported patients) was generally good. Type 3 tumefactive VRs may increase after neurosurgery (5/59 [8.5%] reported patients; 0.5-14 years follow-up) or spontaneously (2/5 [40%] reported patients; 2 and 9 years follow-up), requiring (repeated) neurosurgery.

Conclusion: In type 2 tumefactive VRs, clinical manifestations and signal abnormalities of adjacent brain parenchyma occur in a minority of cases, and follow-up of asymptomatic patients seems unnecessary. In type 3 tumefactive VRs, clinical manifestations are common, concomitant signal abnormalities occur infrequently, and neurosurgical outcome is generally good. Follow-up of type 3 tumefactive VRs is suggested. There are limited data on other types of tumefactive VRs.