Microsurgical and Endoscopic Anatomy of Liliequist's Membrane: A Complex and Variable Structure of the Basal Cisterns

Abstract Objective: Descriptions of Liliequist's membrane, as reported in the literature, vary considerably. In our cadaveric study of Liliequist's membrane, we attempted to clarify and define its anatomic features and boundaries, as well as its relationship with surrounding neurovascular structures. We describe the embryology of this membrane as a remnant of the primary tentorium. The clinical significance of our findings is discussed with respect to third ventriculostomy and surgical approaches to basilar tip aneurysms, suprasellar arachnoid cysts, and perimesencephalic hemorrhage. Methods: Thirteen formalin-fixed adult cadaveric heads were injected with colored silicone. After endoscopic exploration of Liliequist's membrane, a bilateral frontal craniotomy was performed, and the frontal lobes were removed to fully expose Liliequist's membrane. Results: Liliequist's membrane is a complex and highly variable structure that is composed of either a single membrane or two leaves. The membrane was absent in two specimens without any clear demarcation between the interpeduncular, prepontine, and chiasmatic cisterns. Conclusion: Understanding the variable anatomy of Liliequist's membrane is important, particularly to improve current and forthcoming microsurgical and endoscopic neurosurgical procedures. It is important as a surgical landmark in various neurosurgical operations and in the physiopathology of several pathological processes (suprasellar arachnoid cysts and perimesencephalic hemorrhage).

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Prospective surveillance of complications in a pediatric neurosurgery unit

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.1.peds09305 ◽

2010 ◽

Vol 5 (6) ◽

pp. 544-548 ◽

Cited By ~ 28

Author(s):

James M. Drake ◽

Jay Riva-Cambrin ◽

Andrew Jea ◽

Kurtis Auguste ◽

Mandeep Tamber ◽

...

Keyword(s):

External Ventricular Drain ◽

Pediatric Neurosurgery ◽

Shunt Infection ◽

Shunt Revision ◽

Third Ventriculostomy ◽

Neurosurgical Procedures ◽

Csf Leakage ◽

Second Procedure ◽

Shunt Infections ◽

Csf Leaks

Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

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Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Seminars in Plastic Surgery ◽

10.1055/s-0037-1607275 ◽

2017 ◽

Vol 31 (04) ◽

pp. 177-188 ◽

Cited By ~ 7

Author(s):

Soroush Farnoosh ◽

Robert Kellman ◽

Sherard Tatum ◽

Jacob Feldman

Keyword(s):

Skull Base ◽

Surgical Approaches ◽

Trauma Patients ◽

Traumatic Injuries ◽

Surgical Access ◽

Radiographic Testing ◽

Cranial Nerve Injury ◽

Cranial Fossa ◽

Skull Base Anatomy ◽

Neurovascular Structures

AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

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Dysautonomia secondary to third ventriculostomy successfully managed with midodrine

BMJ Case Reports ◽

10.1136/bcr-2019-232767 ◽

2020 ◽

Vol 13 (6) ◽

pp. e232767

Author(s):

Torcato Moreira Marques ◽

André Almeida ◽

Joana Pinheiro ◽

Paula Oliveira Nascimento

Keyword(s):

Blood Pressure ◽

Favourable Result ◽

Third Ventriculostomy ◽

Neurosurgical Procedures ◽

Hypothalamic Dysfunction ◽

On Demand ◽

Hypothalamic Lesions ◽

Adequate Control ◽

Medical Approach

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

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WP1-15 Computer-assisted versus manual planning for stereotactic brain biopsy: retrospective comparative pilot study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.16 ◽

2019 ◽

Vol 90 (3) ◽

pp. e5.3-e4 ◽

Cited By ~ 1

Author(s):

HJ Marcus ◽

VN Vakharia ◽

R Sparks ◽

R Rodionov ◽

N Kitchen ◽

...

Keyword(s):

Brain Biopsy ◽

Computer Assisted ◽

Neurosurgical Procedures ◽

List Type ◽

Stereotactic Brain Biopsy ◽

Trajectory Length ◽

Diagnostic Biopsy ◽

The Mean ◽

Risk Metric ◽

Neurovascular Structures

ObjectivesStereotactic brain biopsy is among the most common neurosurgical procedures. Planning a safe surgical trajectory requires careful attention to a number of features including:traversing the skull perpendicularly;avoiding critical neurovascular structures; andminimising trajectory length.The aim of this study was to develop a platform, SurgiNav, for automated trajectory planning in stereotactic brain biopsy.MethodsA prospectively maintained database was searched between February and August 2017 to identify all adult patients that underwent stereotactic brain biopsy in whom post-operative imaging was available. In each case, the standard pre-operative T1-weighted gadolinium-enhanced MRI was used to generate models of the cortex and vasculature. A surgical trajectory was then generated using automated computer-assisted planning (CAP) and metrics compared to the trajectory of the implemented manual plan (MP) using the paired T-test.Results15 consecutive patients were identified; who had a diagnostic biopsy and there were no immediate complications. Feasible trajectories were generated using CAP in 12 patients, and in these the mean trajectory length using CAP was comparable to MP (31.7 mm vs. 37.1 mm; p=0.3), and mean angle was similarly perpendicular from orthogonal (9.3° vs. 15.3° p=0.1), but the risk-metric was significantly lower (0.16 vs. 0.48; p=0.03).ConclusionsComputer-assisted planning for stereotactic brain biopsy appears feasible in most cases and may be safer in selected cases.

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Surgical Anatomy of the Orbit in Human Cadavers–An Endoscopic Pictorial Documentation

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1606294 ◽

2017 ◽

Vol 79 (02) ◽

pp. 173-176

Author(s):

Homajoun Maslehaty ◽

Saskia Schultheiss ◽

Martin Scholz ◽

Athanasios Petridis

Keyword(s):

Rectus Muscle ◽

Surgical Anatomy ◽

Anatomical Landmark ◽

Inferior Rectus ◽

Anatomical Structures ◽

Topographic Anatomy ◽

Endoscopic Anatomy ◽

Human Cadavers ◽

Formalin Fixed ◽

Inferior Rectus Muscle

Background The aim of our study was a pictorial documentation of the anatomical structures of the orbit. Methods We performed a transmaxillary endoscopic approach in nine formalin-fixed human heads. We identified and documented the anatomy of the inferior part of the orbit. Results The first intraorbital anatomical landmark was the inferior rectus muscle, from which important structures medially and laterally could be identified. Anatomical structures and their relation to each other were documented and presented as illustrative figures. Conclusion Knowledge of the topographic anatomy of the inferior part of the orbit could be sufficiently imparted by our illustrations. The presented transmaxillary approach allowed a wide overview of the anatomical structures located in the inferior part of the orbit. Our pictorial documentation may provide neurosurgeons more safety and the opportunity to become familiar with the endoscopic anatomy.

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Endoscopic opening of the foramen of Magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets

Journal of Neurosurgery ◽

10.3171/jns.2006.105.6.924 ◽

2006 ◽

Vol 105 (6) ◽

pp. 924-927 ◽

Cited By ~ 38

Author(s):

Pierluigi Longatti ◽

Alessandro Fiorindi ◽

Alberto Feletti ◽

Vittorio Baratto

Keyword(s):

Posterior Fossa ◽

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Clinical Symptoms ◽

Therapeutic Option ◽

Surgical Approaches ◽

Third Ventriculostomy ◽

Prepontine Cistern ◽

Suboccipital Craniectomy ◽

Rhomboid Fossa

✓A membrane obstruction of the foramina of Magendie and Luschka is an uncommon origin of hydrocephalus characterized by unusual clinical symptoms of rhomboid fossa hypertension. Various surgical approaches have been proposed to alleviate this obstruction, including opening the obstructed foramen of Magendie using suboccipital craniectomy, shunting procedures, and more recently, endoscopic third ventriculostomy (ETV). In some cases, however, reshaping of the posterior fossa due to the collapse of the prepontine cistern could make ETV difficult for the surgeon and dangerous to the patient. In these cases, endoscopic opening of the foramen of Magendie by transaqueductal navigation of the fourth ventricle is a suitable and feasible therapeutic option.

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Three-dimensional Visualization of Neurovascular Compression: Presurgical Use of Virtual Endoscopy Created from Magnetic Resonance Imaging

Operative Neurosurgery ◽

10.1227/01.neu.0000312347.83182.46 ◽

2008 ◽

Vol 63 (suppl_1) ◽

pp. ONS139-ONS146 ◽

Cited By ~ 6

Author(s):

Tetsuro Takao ◽

Makoto Oishi ◽

Masafumi Fukuda ◽

Go Ishida ◽

Mitsuya Sato ◽

...

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Three Dimensional ◽

Virtual Endoscopy ◽

Surgical Approaches ◽

Data Sets ◽

Neurovascular Compression ◽

Magnetic Resonance Data ◽

Resonance Data ◽

Neurovascular Structures

Abstract Objective: To assess the usefulness of presurgical simulation of microvascular decompression (MVD) by virtual endoscopy (VE), a new tool to analyze three-dimensionally reconstructed magnetic resonance data sets in patients with trigeminal neuralgia or hemifacial spasm (HFS). Methods: In 17 patients (10 with trigeminal neuralgia and seven with HFS) determined to be candidates for MVD, we performed presurgical simulation of MVD using VE. We used constructive interference in steady-state imaging and magnetic resonance angiography to obtain the original images. VE findings were compared with surgical findings. Results: The three-dimensional relations between visible structures seen on VE were consistent with intraoperative findings in all patients. In total, 20 (91%) of 22 neurovascular compression sites in all 17 patients were correctly delineated on VE, with the exception of two small branches identified as offending vessel in two patients with HFS. Perforators that were not apparent on VE limited our ability to accomplish transpositioning of the offending vessels as simulated. The positions of structures that can affect individual surgical approaches, such as the petrosal vein, cerebellar flocculus, and vertebral artery, were also adequately predicted on VE. All patients had excellent surgical outcomes. Conclusion: Presurgical VE in patients with trigeminal neuralgia or HFS is a novel technique that provides excellent visualization of the three-dimensional relations between neurovascular structures and allows simulation of MVD.

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Endoscopic treatment of quadrigeminal arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.7.peds13155 ◽

2013 ◽

Vol 12 (5) ◽

pp. 521-528 ◽

Cited By ~ 18

Author(s):

Nasser M. F. El-Ghandour

Keyword(s):

Surgical Treatment ◽

Endoscopic Treatment ◽

Endoscopic Procedure ◽

Arachnoid Cysts ◽

Third Ventriculostomy ◽

Cyst Size ◽

Shunt Placement ◽

Postoperative Mri ◽

Quadrigeminal Cistern ◽

First Choice

Object Quadrigeminal arachnoid cysts (QACs) are rare, comprising approximately 5%–10% of all intracranial arachnoid cysts. The management of these cysts is challenging, and their optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of QACs in children, focusing on some factors or technical aspects that might influence the outcome. Methods Eighteen children with symptomatic QACs were the subject of this study. The group included 10 boys and 8 girls, with a mean age of 2.5 years. All patients had hydrocephalus. Surgical treatment included ventriculocystostomy (14 cases), endoscopic third ventriculostomy (14 cases), ventriculocystocisternostomy (2 cases), cystocisternostomy (2 cases), and removal of preexisting malfunctioning cystoperitoneal shunt (4 cases). Results Significant clinical improvement occurred in 15 cases (83.3%). Postoperative MRI showed a reduction in the cyst size in 14 cases (77.8%), whereas in the remaining 4 cases (22.2%) the cyst size was unchanged. A postoperative decrease in ventricular size was encountered in 16 cases (88.9%). Minor intraoperative bleeding occurred in 1 case (5.6%), which stopped spontaneously without any postoperative sequelae. Postoperative subdural hygroma occurred in 3 cases (16.7%) and required a subduroperitoneal shunt in 2 cases. During follow-up (mean 45.8 months), a repeat endoscopic procedure was performed in 7 patients (all 4 patients with a prior shunt and 3 patients without a prior shunt), and new shunt placement was required in 5 patients (all 4 patients with a prior shunt and 1 patient without a prior shunt). Thus, none of the patients with a prior shunt was able to become shunt independent, whereas 92.9% of patients without a prior shunt were able to avoid shunt placement. Conclusions Arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy. The procedure is simple, minimally invasive, and associated with low morbidity and mortality rates. The fact that all patients who previously received shunts required a repeat endoscopic procedure and that none of these patients was able to become shunt independent makes it clear that endoscopic treatment should be considered the first choice in the management of patients with arachnoid cysts in the quadrigeminal cistern.

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Interhemispheric transcallosal transchoroidal approach to a pineal teratoma in a 15-year-old boy

Neurosurgical Focus: Video ◽

10.3171/2021.4.focvid2126 ◽

2021 ◽

Vol 5 (1) ◽

pp. V5

Author(s):

Giuseppe Cinalli ◽

Maria Rosaria Scala ◽

Alessandra Marini ◽

Alessia Imperato ◽

Giuseppe Mirone ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Complete Removal ◽

Endoscopic Biopsy ◽

Immature Teratoma ◽

Third Ventriculostomy ◽

Surgical Removal ◽

Transcallosal Approach ◽

Neurovascular Structures ◽

Very High

In this video, the authors present an interhemispheric transcallosal transchoroidal approach to a pineal mass in a 15-year-old boy. He received emergency endoscopic third ventriculostomy (ETV), then an endoscopic biopsy that revealed an immature teratoma. Surgical removal was selected. The mass was located very high in the posterior third ventricle, hidden behind the splenium of the corpus callosum and the vein of Galen, so an interhemispheric transcallosal approach followed by a complete dissection of the whole choroidal fissure was chosen and allowed complete removal of the tumor. Microsurgical dissection is presented, showing clearly in detail all the neurovascular structures encountered. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2126.

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3D Printing-Assisted Skull Base Tumor Surgeries: An Institutional Experience

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1734001 ◽

2021 ◽

Author(s):

Sanjeev Chopra ◽

Ashim Kumar Boro ◽

Virendra Deo Sinha

Keyword(s):

3D Printing ◽

Skull Base ◽

Surgical Approaches ◽

Skull Base Tumor ◽

Confined Space ◽

Skull Base Tumors ◽

Patient Counselling ◽

Training Tool ◽

3D Printed ◽

Neurovascular Structures

AbstractThree-dimensional (3D) printing technology in neurosurgery has gained popularity nowadays. Skull base contains many major neurovascular structures in a confined space, along with anatomical variations making surgical approaches to this region challenging. 3D-printed model of skull base tumors consists of the patient's bony skull base, actual tumor dimensions, and surrounding major neurovascular structures. We included a total number of five patients with skull base tumors (one case of planum sphenoidale meningioma, two cases of sellar tumor with suprasellar extension, and two cases of cerebellopontine angle tumor) and 3D-printed tumor model of each of them. These models were used for preoperative simulation and served as very true to life training tool. These help in increasing the efficacy of the surgeon, improves surgical safety and ergonomics. They were also used for patient counselling, educating about the disease, the surgical procedure, and associated risks.

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