Cerebrospinal fluid diversion in patients with enlarged Virchow-Robin spaces without ventriculomegaly.
OBJECTIVE
Enlarged Virchow-Robin spaces (eVRS) are an MRI biomarker in several neurological diseases of inflammatory, neurodegenerative, vascular, metabolic, or genetic origin. We report on a further condition in which eVRS were observed in patients with an ongoing chronic hydrocephalus-like clinical picture without ventriculomegaly who improved after CSF diversion, and we discuss the possible mechanisms underlying this finding.


METHODS
A retrospective study of seven patients presenting progressive gait, cognitive, and urinary disturbances in association with eVRS was undertaken.


RESULTS
All patients presented an Evans ratio <0.30 and >20 eVRS at the level of basal ganglia and periventricular parenchyma as assessed by T2-weighted MRI. All patients underwent prolonged external lumbar drainage (PELD) with good response. Six patients received ventriculoperitoneal shunt with improvement of their clinical status compared to that before PELD (follow-up: 8-58 months, mean 24.6). The seventh patient did not undergo ventriculoperitoneal shunt and received a second PELD with persistent improvement (follow-up: 14 months).


CONCLUSIONS
Our results indicate that a mechanism involving CSF accumulation and stasis in the subarachnoid space was at least a concurrent factor of this clinical picture. This study should stimulate new perspectives on the role of CSF disturbances in the pathogenesis of diseases associated with VRS enlargement.
Neurosurgical Unit, "Alessandro Manzoni" Hospital, Lecco, Italy.
A
A
Scollato
Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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P
Gallina
Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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N
Di Lorenzo
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013346:Subarachnoid Space / Q000473:pathology; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
Virchow-Robin spaces; cerebrospinal fluid diversion; cerebrospinal fluid dynamics; normal pressure hydrocephalus