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Three-dimensional observation of Virchow-Robin spaces in the basal ganglia and white matter and their relevance to idiopathic normal pressure hydrocephalus.

Ishikawa M, Yamada S, Yamamoto K - Fluids Barriers CNS (2015)

Bottom Line: No significant changes were noted in basal ganglia VRS.VRS in the basal ganglia were seen as genuine perivascular spaces; while neither communication with subarachnoid spaces nor arteries were seen in white matter VRS, even by 3D-CISS sequences and high-resolution magnetic resonance angiography on 3T-MRI.White matter VRS were sparse in patients with iNPH and they were mildly decreased in diameter, but did not change in number after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Otowa, Yamashina-ku, Kyoto, 607-8062, Japan. rakuwadr1001@rakuwadr.com.

ABSTRACT

Background: Virchow-Robin spaces (VRS) are brain perivascular spaces containing perforating arteries. Although enlarged VRS are associated with various disorders such as Alzheimer's disease, cerebrovascular disease, and head trauma, their functional role remains unclear. Using highly fluid-sensitive magnetic resonance imaging (MRI) sequences, fine morphological features of VRS and their relevance to idiopathic normal pressure hydrocephalus (iNPH) were investigated.

Methods: Three-dimensional constructive interference in steady state (3D-CISS) on 3 Tesla MRI was applied to 29 individuals. The morphology and number of VRS in the basal ganglia and white matter were compared between 20 patients with iNPH and nine age-matched controls. The VRS number per hemisphere was classified into three grades: few, moderate, and abundant.

Results: Virchow-Robin spaces in the basal ganglia were curved, irregularly sized and shaped, and communicated with the cerebrospinal fluid in the subarachnoid space; they contained perforating arteries. VRS in the white matter were straight, smooth, homogeneously sized and shaped, and did not penetrate the cortex. Arteries were not seen in VRS of the white matter. White matter VRS were sparse in patients with iNPH. In contrast, basal ganglia VRS positively correlated with age. Postoperatively after shunt surgery, VRS in the white matter were mildly decreased in diameter, but not in number. No significant changes were noted in basal ganglia VRS.

Conclusions: The present study revealed different morphological features of VRS in the basal ganglia and white matter. VRS in the basal ganglia were seen as genuine perivascular spaces; while neither communication with subarachnoid spaces nor arteries were seen in white matter VRS, even by 3D-CISS sequences and high-resolution magnetic resonance angiography on 3T-MRI. White matter VRS were sparse in patients with iNPH and they were mildly decreased in diameter, but did not change in number after surgery. At present, it remains unclear whether the white matter VRS are dilated interstitial fluid spaces or cerebral amyloid angiopathy, or both. Further studies are necessary to elucidate the functional role of VRS in normal subjects and patients with iNPH.

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Related in: MedlinePlus

Postoperative constructive interference in the steady state images 4 months after shunt surgery in a patient with iNPH. Preoperative images (a–c) and postoperative images (d–f); a, d coronal sections, b, e axial sections at the level of corticomedullary junction. c, f axial sections at the level of basal ganglia. Inserts at right upper corner are magnified views of arrow-indicated VRS. Short-stepped gait was improved immediately after surgery. The CISS images 4 months after surgery showed mild decrease in VRS diameter in the white matter, although there were no significant changes in number. No significant changes were noted in basal ganglia VRS, observation in a 68-year-old patient with iNPH.
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Fig9: Postoperative constructive interference in the steady state images 4 months after shunt surgery in a patient with iNPH. Preoperative images (a–c) and postoperative images (d–f); a, d coronal sections, b, e axial sections at the level of corticomedullary junction. c, f axial sections at the level of basal ganglia. Inserts at right upper corner are magnified views of arrow-indicated VRS. Short-stepped gait was improved immediately after surgery. The CISS images 4 months after surgery showed mild decrease in VRS diameter in the white matter, although there were no significant changes in number. No significant changes were noted in basal ganglia VRS, observation in a 68-year-old patient with iNPH.

Mentions: Postoperatively, the symptoms, especially of gait disturbance, were improved after shunt surgery in all patients treated. Follow-up MRIs were taken 1–10 months after surgery in four patients. On magnified view of the CISS images, a small decrease in VRS diameter was noted in the white matter, especially near the corticomedullary junction, although there were no significant changes in VRS number (Figure 9). In the basal ganglia, there were no significant changes in VRS number and diameter.Figure 9


Three-dimensional observation of Virchow-Robin spaces in the basal ganglia and white matter and their relevance to idiopathic normal pressure hydrocephalus.

Ishikawa M, Yamada S, Yamamoto K - Fluids Barriers CNS (2015)

Postoperative constructive interference in the steady state images 4 months after shunt surgery in a patient with iNPH. Preoperative images (a–c) and postoperative images (d–f); a, d coronal sections, b, e axial sections at the level of corticomedullary junction. c, f axial sections at the level of basal ganglia. Inserts at right upper corner are magnified views of arrow-indicated VRS. Short-stepped gait was improved immediately after surgery. The CISS images 4 months after surgery showed mild decrease in VRS diameter in the white matter, although there were no significant changes in number. No significant changes were noted in basal ganglia VRS, observation in a 68-year-old patient with iNPH.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482202&req=5

Fig9: Postoperative constructive interference in the steady state images 4 months after shunt surgery in a patient with iNPH. Preoperative images (a–c) and postoperative images (d–f); a, d coronal sections, b, e axial sections at the level of corticomedullary junction. c, f axial sections at the level of basal ganglia. Inserts at right upper corner are magnified views of arrow-indicated VRS. Short-stepped gait was improved immediately after surgery. The CISS images 4 months after surgery showed mild decrease in VRS diameter in the white matter, although there were no significant changes in number. No significant changes were noted in basal ganglia VRS, observation in a 68-year-old patient with iNPH.
Mentions: Postoperatively, the symptoms, especially of gait disturbance, were improved after shunt surgery in all patients treated. Follow-up MRIs were taken 1–10 months after surgery in four patients. On magnified view of the CISS images, a small decrease in VRS diameter was noted in the white matter, especially near the corticomedullary junction, although there were no significant changes in VRS number (Figure 9). In the basal ganglia, there were no significant changes in VRS number and diameter.Figure 9

Bottom Line: No significant changes were noted in basal ganglia VRS.VRS in the basal ganglia were seen as genuine perivascular spaces; while neither communication with subarachnoid spaces nor arteries were seen in white matter VRS, even by 3D-CISS sequences and high-resolution magnetic resonance angiography on 3T-MRI.White matter VRS were sparse in patients with iNPH and they were mildly decreased in diameter, but did not change in number after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Otowa, Yamashina-ku, Kyoto, 607-8062, Japan. rakuwadr1001@rakuwadr.com.

ABSTRACT

Background: Virchow-Robin spaces (VRS) are brain perivascular spaces containing perforating arteries. Although enlarged VRS are associated with various disorders such as Alzheimer's disease, cerebrovascular disease, and head trauma, their functional role remains unclear. Using highly fluid-sensitive magnetic resonance imaging (MRI) sequences, fine morphological features of VRS and their relevance to idiopathic normal pressure hydrocephalus (iNPH) were investigated.

Methods: Three-dimensional constructive interference in steady state (3D-CISS) on 3 Tesla MRI was applied to 29 individuals. The morphology and number of VRS in the basal ganglia and white matter were compared between 20 patients with iNPH and nine age-matched controls. The VRS number per hemisphere was classified into three grades: few, moderate, and abundant.

Results: Virchow-Robin spaces in the basal ganglia were curved, irregularly sized and shaped, and communicated with the cerebrospinal fluid in the subarachnoid space; they contained perforating arteries. VRS in the white matter were straight, smooth, homogeneously sized and shaped, and did not penetrate the cortex. Arteries were not seen in VRS of the white matter. White matter VRS were sparse in patients with iNPH. In contrast, basal ganglia VRS positively correlated with age. Postoperatively after shunt surgery, VRS in the white matter were mildly decreased in diameter, but not in number. No significant changes were noted in basal ganglia VRS.

Conclusions: The present study revealed different morphological features of VRS in the basal ganglia and white matter. VRS in the basal ganglia were seen as genuine perivascular spaces; while neither communication with subarachnoid spaces nor arteries were seen in white matter VRS, even by 3D-CISS sequences and high-resolution magnetic resonance angiography on 3T-MRI. White matter VRS were sparse in patients with iNPH and they were mildly decreased in diameter, but did not change in number after surgery. At present, it remains unclear whether the white matter VRS are dilated interstitial fluid spaces or cerebral amyloid angiopathy, or both. Further studies are necessary to elucidate the functional role of VRS in normal subjects and patients with iNPH.

Show MeSH
Related in: MedlinePlus