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Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases

Belal Neyazi, Vanessa Magdalena Swiatek, Klaus-Peter Stein, Karl Hartmann, Ali Rashidi, Seraphine Zubel, Amir Amini, and I. Erol Sandalcioglu

instability. Diagnostic testing included MRI, which revealed a multicystic lesion in the area of the right basal ganglia and extending into the mesencephalon and pedunculus cerebelli ( Fig. 1B ). Importantly, there were no signs of hydrocephalus. Prior to presenting at our clinic, the patient had already undergone endoscopic third ventriculostomy and biopsy at a different hospital. Postoperatively, there was neither improvement nor a worsening of symptoms, and MRI findings remained stable. This case underscores the challenges associated with managing multicystic lesions in

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Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

Khoa N Nguyen, Lindsey M Freeman, Timothy H Ung, Steven Ojemann, and Fabio Grassia

to red blood cells (2,000) on cell count. The differential resulted in 8% neutrophils, 65% lymphocytes, and 27% monocytes. Cultures were negative. Four days later, the patient underwent planned endoscopic third ventriculostomy (ETV). An intraoperative decision was made to also complete an endoscopic biopsy. Induction of general anesthesia, endotracheal intubation, and patient head fixation in a neutral 30° elevated position were completed in typical fashion. After the usual surgical preparation, a right frontal burr hole was made at Kocher’s point, and the dura