Liliequist membrane: radiological evaluation, clinical
                    and therapeutic implications

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

Daniel Aguiar Dias 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.

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.

Fábio Luiz Onuki Castro

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.

James Henrique Yared

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.

Ademar Lucas Júnior

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.

Luiz Alves Ferreira Filho

Nelson Fortes Paes Diniz Ferreira

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.

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

Figures

Figures (6)

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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.⁽ ¹1. Fushimi Y, Miki Y, Ueba T, et al. Liliequist membrane: three-dimensional constructive interference in steady state MR imaging. Radiology. 2003;229:360-5. ⁾).

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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.

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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).

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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.

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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.

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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).

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.⁽ ¹1. Fushimi Y, Miki Y, Ueba T, et al. Liliequist membrane: three-dimensional constructive interference in steady state MR imaging. Radiology. 2003;229:360-5. ⁾).

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.

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).

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.

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.

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).

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E-mail: radiologiabrasileira@cbr.org.br

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