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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