The membrane of Liliequist—a safe haven in the middle of the brain. A narrative review

Volovici, Victor; Varvari, Ioana; Dirven, Clemens; Dammers, Rúben

doi:10.1007/s00701-020-04290-0

Cited by 17 publications

(9 citation statements)

References 30 publications

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“…Beneath the third ventricle lies the membrane of Liliequist. This partially trabecular and partially dense structure presents a projection of the arachnoid membrane [ 14 ]. It consists of three segments, which separate the chiasmatic, interpeduncular and prepontine cisterns [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Microanatomic Morphometric Characteristics of the Third Ventricle Floor

et al. 2023

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Background: Endoscopic third ventriculostomy (ETV) is an effective treatment for hydrocephalus. The in-depth understanding of microanatomy is essential for accurate diagnosis, treatment and complications prevention. The aim of this study is to supplement the knowledge gap regarding the microanatomical metrics and correlations for which the literature includes only scarce mentions at best. Methods: This is a descriptive microanatomical study including 25 cadaver brains. Specimens from donors with neurological, psychiatric disorders or alcohol abuse were excluded. Surgical loops were used for harvesting. High-precision tools were employed to dissect and measure the anatomical landmarks under a surgical microscope. Each measurement was performed in three consecutive attempts and outliers were rejected. RStudio was used for statistical analysis. Distribution was evaluated employing the Shapiro–Wilk test. Normally distributed values were presented as mean and standard deviation, and others as median and interquartile range. Results: The age of the donors was 61.72 (±10.08) years. The distance from the anterior aspect of the foramen of Monro to the anterior margin of the mamillary body was 16.83 (±1.04) mm, and to the posterior margin was 16.76 (±1.9) mm. The distance from the anterior mamillary body margin to the infundibulum was 6.39 (±1.9) mm, to the optic recess was 8.25 (±1.84) mm, and to the apex of the vertebral artery was 5.05 (±1.62) mm. The distance from the anterior commissure to the brain aqueduct was 22.46 (±2.29) mm, and to the infundibulum was 13.93 (±2.54) mm. The mamillary body diameter was 4.91 (±0.34) mm in the anteroposterior and 4.21 (±0.48) mm in the cranio-caudal plane. The intraventricular segment was protruding by 1.63 (±0.46) mm. The diameter of the hypothalamus on the anterior margin of mamillary bodies was 1.37 (±0.75) mm, of the Liliequist membrane was 0.19 (±0.07) mm and of the lamina terminalis was 0.35 (±0.32) mm. Conclusion: The presented microanatomical measurements and correlations are expected to contribute to the improvement of ETV safety.

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Section: Discussionmentioning

confidence: 99%

Microanatomic Morphometric Characteristics of the Third Ventricle Floor

et al. 2023

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“…Heterogeneity both in the superficial subarachnoid and basal cisterns seems to be the rule in all anatomical studies. Some of the variations arise from the expected variability during embryogenesis, others from the type of study conducted and method being used 35. The volumes of trabeculae differ between subjects and locations.…”

Section: Discussionmentioning

confidence: 99%

Transvascular in vivo microscopy of the subarachnoid space

Anagnostakou

Epshtein

Ughi

et al. 2022

J NeuroIntervent Surg

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BackgroundThe micro-architectonics of the subarachnoid space (SAS) remain partially understood and largely ignored, likely the result of the inability to image these structures in vivo. We explored transvascular imaging with high-frequency optical coherence tomography (HF-OCT) to interrogate the SAS.MethodsIn vivo HF-OCT was performed in 10 dogs in both the posterior and anterior cerebral circulations. The conduit vessels used were the basilar, anterior spinal, and middle and anterior cerebral arteries through which the perivascular SAS was imaged. The HF-OCT imaging probe was introduced via a microcatheter and images were acquired using a contrast injection (3.5 mL/s) for blood clearance. Segmentation and three-dimensional rendering of HF-OCT images were performed to study the different configurations and porosity of the subarachnoid trabeculae (SAT) as a function of location.ResultsOf 13 acquisitions, three were excluded due to suboptimal image quality. Analysis of 15 locations from seven animals was performed showing six distinct configurations of arachnoid structures in the posterior circulation and middle cerebral artery, ranging from minimal presence of SAT to dense networks and membranes. Different locations showed predilection for specific arachnoid morphologies. At the basilar bifurcation, a thick, fenestrated membrane had a unique morphology. SAT average thickness was 100 µm and did not vary significantly based on location. Similarly, the porosity of the SAT averaged 91% and showed low variability.ConclusionWe have demonstrated the feasibility to image the structures of the SAS with transvascular HF-OCT. Future studies are planned to further map the SAT to increase our understanding of their function and possible impact on neurovascular pathologies.

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“…[2,8] Neurosurgical studies have described physiological perforations in Liliequist membrane. [9] Cases of spontaneous third ventriculostomy have been reported in patients of chronic hydrocephalus. [10] Cavalheiro et al in 2021 reported spontaneous third ventriculostomy in three cases of myelomeningocele and were able to demonstrate flow void across the site of Liliequist membrane on MRI in two cases.…”

Section: Discussionmentioning

confidence: 99%

“…Neurosurgical studies have described physiological perforations in Liliequist membrane. [ 9 ] Cases of spontaneous third ventriculostomy have been reported in patients of chronic hydrocephalus. [ 10 ] Cavalheiro et al .…”

Section: Discussionmentioning

confidence: 99%

Chiari III malformation with defect in Liliequist membrane on MR imaging

Arora

Vani

2022

JNRP

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The Liliequist membrane is a radiologically neglected structure, with routine evaluation only carried out in pre-operative and post-operative cases of third ventriculostomy. We report two cases of Chiari III malformation in two unrelated females with similar findings on magnetic resonance imaging study including occipital and low cervical encephalocele, hydrocephalus, and segmentation anomalies in cervical spine. Along with these findings, we report a flow void on T2-weighted images observed in both cases across the site of Liliequist membrane between interpeduncular and chiasmatic cistern. Our findings of CSF flow across the Liliequist membrane may represent spontaneous third ventriculostomy or another congenital defect in the myriad of anomalies seen in cases of Chiari III malformation.

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The membrane of Liliequist—a safe haven in the middle of the brain. A narrative review

Cited by 17 publications

References 30 publications

Microanatomic Morphometric Characteristics of the Third Ventricle Floor

Microanatomic Morphometric Characteristics of the Third Ventricle Floor

Transvascular in vivo microscopy of the subarachnoid space

Chiari III malformation with defect in Liliequist membrane on MR imaging

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