Anterior temporal lobe perivascular spaces

Dr Craig Hacking and A.Prof Frank Gaillard et al.

Anterior temporal lobe perivascular spaces are recently recognised special variants of tumefactive perivascular spaces, which can mimic cystic tumours with surrounding oedema.

A predilection for women has been reported 1. Age range is wide, from 24 to 86 years old reported 1.

As is the case with perivascular spaces elsewhere, no symptoms directly attributable to the lesion are usually identified 1.

Unlike tumefactive perivascular spaces elsewhere within the brain, anterior temporal lobe perivascular spaces often have surrounding oedema (~80%) which can range from mild to extensive 1. Additionally, they are usually associated with a branch of the middle cerebral artery and a focal region of cortical thinning or absence (~90%) 1. Otherwise, they have similar appearances to perivascular spaces elsewhere: internal CSF signal on all sequences and no enhancement 1,2.

The size of the cyst invariably remains stable. Surrounding oedema, however, can change over time in a small percentage of cases, either increasing or decreasing in conspicuity 1,2.

No treatment is required provided that they are recognised as perivascular spaces. Change in the size of the cyst or presence of enhancement should make one doubt the diagnosis. In some instances, particularly those with increasing oedema, a biopsy may be required to exclude a tumour. Care must be taken, however, as reactive astrocytosis can be mistaken for a glial tumour leading to further surgery and treatment, especially as the tissue will naturally enough be IDH wildtype

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rID: 39734
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