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The role of the Liliequist membrane in the third ventriculostomy

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Abstract

Endoscopic third ventriculostomy (ETV) is a hydrocephalus treatment procedure that involves opening the Liliequist membrane (LM). However, LM anatomy has not been well-studied neuroendoscopically, because approach angles differ between descriptive and microsurgical anatomical explorations. Discrepancies in ETV efficacy, especially among children age 2 and younger, may be due to incomplete LM opening. The objective of this study was to characterize the LM anatomically from a neuroendoscopic perspective to better understand the impact of anatomical features during LM ostomy and the ETV success rate. Additionally, the ETV success score was tested to predict patient outcome after the intraoperatively difficult opening of LM. Fifty-four patients who underwent ETV were prospectively analyzed with a mean follow-up of 53.1 months (1–90 months). The ETV technical parameters of difficulty were validated by seven expert neurosurgeons. The pediatric population (44) of this study represents the majority of patients (81.4%). The overall ETV success rate was 68.5%. Anomalies on the IIIVT floor resulted in an increased rate of ETV failure. The IIIVT was anomalous, and LM was thick in 33.3% of cases. Fenestration of LM was difficult in 39% of cases, and the LM and TC were opened separately in 55.6% of cases. The endoscopic third ventriculostomy success score (ETVSS) accurately predicted the level of difficulty opening the LM (p = 0.012), and the group with easy opening presented greater durability in ETV success. Neurosurgeons should be aware of the difficulty level of the overture of LM during ETV and its impact on long-term ETV effectiveness.

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Acknowledgements

To the neurosurgeons who participated in the face validity

Prof. Alexandre Giannetti - Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte - Brazil

Dr. Arthur da Cunha - Hospital da Restauração, Recife - Brazil

Prof. Hamilton Matushita - Hospital das Clínicas, University of São Paulo - USP of São Paulo - Brazil

Prof. Jorge Bizzi - Hospital das Clínicas, Federal University of Rio Grande do Sul - Brazil

Prof. Ricardo Santos de Oliveira - Hospital das Clínicas, University of São Paulo – USP of Ribeirão Preto

Prof. Roberto Dezena - Hospital das Clínicas, Federal University of the Triângulo Mineiro - Brazil

Prof. Samuel Zymberg - Hospital São Paulo - Universidade Federal de São Paulo - Federal University of São Paulo, São Paulo - Brazil

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Vila da Serra Hospital and Biocor Institute, Nova Lima, Minas Gerais, Brazil

    José Aloysio da Costa Val Filho & Leopoldo Mandic Ferreira Furtado

  2. Department of Surgery, Faculty of Medicine and Department of Pediatric Neurosurgery of Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    José Aloysio da Costa Val Filho, Sebastião Nataniel da Silva Gusmão & Leopoldo Mandic Ferreira Furtado

  3. Department of Neurosurgery, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil

    Guaracy de Macedo Machado Filho & Fernando Levi Alencar Maciel

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  1. José Aloysio da Costa Val Filho
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  2. Sebastião Nataniel da Silva Gusmão
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Contributions

Conceptualization: José Aloysio da Costa Val FilhoMethodology: José Aloysio da Costa Val FilhoFormal analysis and investigation: José Aloysio da Costa Val FilhoWriting - original draft preparation: Leopoldo Mandic Ferreira Furtado, Guaracy de Macedo Machado Filho, and Fernando Levi Alencar MacielWriting - review and editing: Leopoldo Mandic Ferreira Furtado, José Aloysio da Costa Val FilhoSupervision: Sebastião Nataniel da Silva Gusmão

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Correspondence to José Aloysio da Costa Val Filho.

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da Costa Val Filho, J.A., da Silva Gusmão, S.N., Furtado, L.M.F. et al. The role of the Liliequist membrane in the third ventriculostomy. Neurosurg Rev 44, 3375–3385 (2021). https://doi.org/10.1007/s10143-021-01508-2

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