Liliequist membrane: radiological evaluation, clinical
                    and therapeutic implications

Dias, Daniel Aguiar; Castro, Fábio Luiz Onuki; Yared, James Henrique; Lucas Júnior, Ademar; Ferreira, Nelson Fortes Paes Diniz; Ferreira Filho, Luiz Alves

doi:10.1590/0100-3984.2013.1809

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ICONOGRAPHIC ESSAYS • Radiol Bras 47 (3) • May-Jun 2014 • https://doi.org/10.1590/0100-3984.2013.1809 linkcopy

Liliequist membrane: radiological evaluation, clinical and therapeutic implications^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In a simplistic and succinct way, Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies. In spite of being well known to neurosurgeons, many radiologists neither know this anatomical structure nor give importance to its study. The imaging evaluation of this membrane is feasible and may be interesting for a better preoperative planning; postoperative evaluation of third ventriculostomies; and understanding of suprasellar arachnoid cysts and perimesencephalic hemorrhage. The present article illustrates the anatomy of the membrane, with emphasis on imaging findings, besides describing its possible clinical and surgical implications.

Membrane; Liliequist; Third ventriculostomy; Magnetic resonance imaging; Neuroradiology

Authorship

person Daniel Aguiar Dias

schoolMDs, Neuroradiology and Head & Neck Fellows at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMDs, Neuroradiology and Head & Neck Fellows at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.

person Fábio Luiz Onuki Castro

schoolMD, Neuroradiologist at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.

person James Henrique Yared

schoolMD, Neuroradiologist at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

person Ademar Lucas Júnior

schoolMD, Neuroradiologist and Head & Neck Radiology, Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist and Head & Neck Radiology, Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

person Luiz Alves Ferreira Filho

person Nelson Fortes Paes Diniz Ferreira

schoolMD, Head of the Neuroradiology Unit at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Head of the Neuroradiology Unit at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

Mailing Address: Dr. Daniel Aguiar Dias. Rua Deputado Moreira da Rocha, 500, ap. 1600, Meireles. Fortaleza, CE, Brazil, 60160-060. E-mail:
daniel_aguiar@ hotmail.com.

SCIMAGO INSTITUTIONS RANKINGS

MDs, Neuroradiology and Head & Neck Fellows at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMDs, Neuroradiology and Head & Neck Fellows at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.

MD, Neuroradiologist at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist at Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.

MD, Neuroradiologist at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

MD, Neuroradiologist and Head & Neck Radiology, Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Neuroradiologist and Head & Neck Radiology, Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

MD, Head of the Neuroradiology Unit at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.Hospital do CoraçãoBrazilSão Paulo, SP, BrazilMD, Head of the Neuroradiology Unit at Hospital do Coração (HCor), Teleimagem, and Alta, São Paulo, SP, Brazil.

Figures

Figures (6)

Thumbnail

Figure 1 Schematic illustration of the LM anatomy, demonstrating the three segments of the Liliequist membrane in the sagittal plane. S, sellar segment; M, mesencephalic segment; D, diencephalic segment. (Modified by Fushimi et al.⁽ ¹ ⁾).

Thumbnail

Figure 2 Radiological anatomy. Sagittal (slightly paramedian) CISS image clearly demonstrating the LM and its three segments. Note the membrane insertion into the mammillary body, and its thickness much inferior to that of the third ventricle floor. The white arrow identifies the sellar segment; the black arrow, the diencephalic segment; and the arrow head, the mesencephalic segment.

Thumbnail

Figure 3 Radiological anatomy. CISS image with isotropic acquisition, which allows later multiplanar reformation, as above demonstrated in the coronal plane, highlighting lateral insertions of the LM adjacent to the sheaths of the third pairs of cranial nerves – an aspect that is more clearly demonstrated at right (arrow).

Thumbnail

Figure 4 Failure of third-ventriculostomy. Postoperative image of endoscopic third-ventriculostomy. The presence of an intense flow artifact through the cerebral acqueduct toward the fourth ventricle is highlighted. Note the absence of flow identifiable by ventriculostomy orifice in the third ventricle, that is patent and wide (white arrow). Note the membrane in the pre-pontine cistern (black arrow) that may correspond to the lowered, intact Liliequist membrane or even pre-pontine membrane. Also, a remarkable global dilatation of the ventricular system is observed, probably resulting from obstruction at the level of the fourth ventricle output pathways where no sign of liquor cerebrospinalis flow is observed.

Thumbnail

Figure 5 Suprasellar arachnoid cyst. Paramedian sagittal CISS image (A) and conventional, coronal, T2-weighted image (B). Note the presence of a large cystic mass insinuating from the suprasellar region toward the interior of the third and lateral right ventricle. On A it is possible to note the presence of the Liliequist membrane (arrow) forming the cystic wall.

Thumbnail

Figure 6 Perimesencephalic hemorrhage. Spontaneously hyperdense hematic material at the level of the interpeduncular cistern (non-contrast-enhanced computed tomography – image on A). Digital subtraction angiography (image on B) did not demonstrate any aneurysmal malformation (in this case, for illustrative purposes, demonstrating only the posterior circulation).

imageFigure 1 Schematic illustration of the LM anatomy, demonstrating the three segments of the Liliequist membrane in the sagittal plane. S, sellar segment; M, mesencephalic segment; D, diencephalic segment. (Modified by Fushimi et al.⁽ ¹ ⁾). open_in_new

imageFigure 2 Radiological anatomy. Sagittal (slightly paramedian) CISS image clearly demonstrating the LM and its three segments. Note the membrane insertion into the mammillary body, and its thickness much inferior to that of the third ventricle floor. The white arrow identifies the sellar segment; the black arrow, the diencephalic segment; and the arrow head, the mesencephalic segment. open_in_new

imageFigure 3 Radiological anatomy. CISS image with isotropic acquisition, which allows later multiplanar reformation, as above demonstrated in the coronal plane, highlighting lateral insertions of the LM adjacent to the sheaths of the third pairs of cranial nerves – an aspect that is more clearly demonstrated at right (arrow). open_in_new

imageFigure 4 Failure of third-ventriculostomy. Postoperative image of endoscopic third-ventriculostomy. The presence of an intense flow artifact through the cerebral acqueduct toward the fourth ventricle is highlighted. Note the absence of flow identifiable by ventriculostomy orifice in the third ventricle, that is patent and wide (white arrow). Note the membrane in the pre-pontine cistern (black arrow) that may correspond to the lowered, intact Liliequist membrane or even pre-pontine membrane. Also, a remarkable global dilatation of the ventricular system is observed, probably resulting from obstruction at the level of the fourth ventricle output pathways where no sign of liquor cerebrospinalis flow is observed. open_in_new

imageFigure 5 Suprasellar arachnoid cyst. Paramedian sagittal CISS image (A) and conventional, coronal, T2-weighted image (B). Note the presence of a large cystic mass insinuating from the suprasellar region toward the interior of the third and lateral right ventricle. On A it is possible to note the presence of the Liliequist membrane (arrow) forming the cystic wall. open_in_new

imageFigure 6 Perimesencephalic hemorrhage. Spontaneously hyperdense hematic material at the level of the interpeduncular cistern (non-contrast-enhanced computed tomography – image on A). Digital subtraction angiography (image on B) did not demonstrate any aneurysmal malformation (in this case, for illustrative purposes, demonstrating only the posterior circulation). open_in_new

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Liliequist membrane: radiological evaluation, clinical and therapeutic implications*

Abstract

Liliequist membrane: radiological evaluation, clinical and therapeutic implications^*