Passanisi Maurizio, Marrone Salvatore, Scalia Gianluca, Cicero Salvatore, Chaurasia Bipin, Umana Giuseppe E
Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital.
Department of Neurosurgery, Sant'Elia Hospital, Caltanissetta.
Ann Med Surg (Lond). 2024 Aug 22;86(10):6231-6235. doi: 10.1097/MS9.0000000000002493. eCollection 2024 Oct.
Multinodular and Vacuolating Posterior Fossa Lesions of Unknown Significance (MV PLUS) are benign cystic lesions that, though typically asymptomatic, can present with neurological symptoms such as seizures, headaches, and syncope. These lesions are predominantly found in sub-tentorial brain structures but can also appear in supratentorial areas. MRI is crucial in detecting these lesions, characterized by small nodules with high intensity on T2-FLAIR sequences. Despite increasing awareness, the pathophysiology and classification of MV PLUS lesions remain unclear, necessitating further research and careful monitoring.
A 52-year-old female presented with subjective dizziness and a recent syncope episode. Neurological examination showed ataxia and a positive Romberg sign. MRI revealed a multicystic and nodular lesion in the vermian and paravermian regions, with altered signal intensity on T1-weighted and FLAIR sequences. The lesion showed no pathological enhancement post-gadolinium administration, and spectroscopy revealed no significant metabolite peaks. Clinical improvement was observed following corticosteroid and antivertiginous therapy, and the patient was discharged with a recommendation for neuroradiological follow-up.
MV PLUS lesions are a subset of multinodular and vacuolating lesions that present significant diagnostic challenges due to their complex radiological features. First described in 2013, these lesions have distinct MRI characteristics, including a nodular appearance with high T2-FLAIR intensity and occasional cystic components. Despite being benign and typically stable, the differential diagnosis includes various other intracranial lesions, requiring careful evaluation. The pathogenesis and optimal management strategies for MV PLUS lesions are still under investigation, emphasizing the need for continued research.
MV PLUS lesions, although rare and benign, present unique diagnostic challenges due to their varied radiological features and potential neurological symptoms. Regular MRI monitoring is essential to track their stability, given the current lack of understanding regarding their pathophysiology and long-term implications. Further research is needed to elucidate the etiology, natural history, and optimal management of these intriguing lesions.
意义不明的多结节及空泡化后颅窝病变（MV PLUS）是良性囊性病变，尽管通常无症状，但可出现癫痫发作、头痛和晕厥等神经症状。这些病变主要见于幕下脑结构，但也可出现在幕上区域。MRI对于检测这些病变至关重要，其特征是在T2-FLAIR序列上有高强度小结节。尽管认识有所提高，但MV PLUS病变的病理生理学和分类仍不清楚，需要进一步研究和密切监测。
一名52岁女性出现主观头晕和近期晕厥发作。神经系统检查显示共济失调和Romberg征阳性。MRI显示蚓部和蚓旁区域有一个多囊性和结节性病变，在T1加权和FLAIR序列上信号强度改变。病变在给予钆剂后无病理性强化，磁共振波谱显示无明显代谢物峰。皮质类固醇和抗眩晕治疗后临床症状改善，患者出院时被建议进行神经放射学随访。
MV PLUS病变是多结节及空泡化病变的一个子集，因其复杂的放射学特征而带来重大诊断挑战。这些病变于2013年首次被描述，具有独特的MRI特征，包括T2-FLAIR高强度的结节状外观和偶尔的囊性成分。尽管是良性且通常稳定，但鉴别诊断包括各种其他颅内病变，需要仔细评估。MV PLUS病变的发病机制和最佳管理策略仍在研究中，强调了持续研究的必要性。
MV PLUS病变虽然罕见且为良性，但其多样的放射学特征和潜在的神经症状带来了独特的诊断挑战。鉴于目前对其病理生理学和长期影响缺乏了解，定期MRI监测对于跟踪其稳定性至关重要。需要进一步研究以阐明这些有趣病变的病因、自然史和最佳管理方法。
