title: Neuroendoscopic treatment of symptomatic giant Virchow-Robin spaces.
abstract: BACKGROUND
  Virchow-Robin spaces (VRS) or perivascular spaces are interstitial cystic spaces surrounding the vasculature of brain parenchyma and course from the subarachnoid space. Small VRS (<2 mm) appear in all age groups, but can enlarge and be confused with other lesions like cystic neoplasms. These enlarged VRS are termed giant tumefactive perivascular spaces (GRPVS).
  
  
  METHODS
  We present the case of a 50-year-old male who presents with right eye pain, blurred vision, headache, and gait imbalance. He was diagnosed with GRPVS and underwent an endoscopic third ventriculostomy and cyst fenestration. Postoperative imaging showed a decrease in size of the ventricular system with evidence of flow through the aqueduct and ventriculostomy. Brainstem VRS cysts decreased in size.
  
  
  CONCLUSIONS
  Unlike the other small number of case reports, this patient is unique in his age of presentation and successful endoscopic method of treatment. The endoscopic approach provided great exposure and adequate access to the lesions. Clinically, symptoms improved, cyst size decreased, and need for permanent shunt placement was averted.
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Kyle Anthony
authors.initials: KA
authors.lastname: Smith
authors.affiliation: School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Lavin
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Roukoz
authors.initials: R
authors.lastname: Chamoun
keywords: Cyst fenestration; Virchow–Robin spaces; endoscopy; neuroendoscopy