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Clinical Neurology and Neurosurgery Jul 2024The Liliequist membrane (LM) represents a crucial yet challenging anatomical structure in neuroanatomy. First observed in 1875 and later elucidated by Bengt Liliequist... (Review)
Review
BACKGROUND
The Liliequist membrane (LM) represents a crucial yet challenging anatomical structure in neuroanatomy. First observed in 1875 and later elucidated by Bengt Liliequist in 1956, the LM's precise anatomical description and boundaries remain complex. Its significance extends to neurosurgery, impacting various procedures like endoscopic third ventriculocisternostomies, aneurysm and tumor surgeries, treatment of suprasellar arachnoid cysts, and managing perimesencephalic hemorrhages. However, a comprehensive understanding of the LM is hindered by inconsistent anatomical descriptions and limitations in available literature, warranting a systematic review.
METHODS
A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining to Liliequist's membrane. The search employed Mesh terms like "Liliequist membrane," "Liliequist's diaphragm," and related variations. Inclusion criteria encompassed studies exploring the historical evolution, anatomical structure, radiological characteristics, and clinical implications of the LM in neurosurgery.
RESULTS
The search yielded 358 articles, with 276 unique articles screened based on relevance. Following a meticulous screening process, 72 articles underwent full-text assessment, resulting in the inclusion of 5 articles meeting the eligibility criteria. The selected studies varied in methodology, including anatomical dissections, radiological evaluations, and clinical significance in neurosurgical procedures. Insights were derived on LM's anatomical variations, radiological visualization, and its critical role in guiding neurosurgical interventions.
CONCLUSIONS
Despite advancements in understanding its clinical significance and radiological visualization, challenges persist in precisely delineating its boundaries. Further research, especially on embryological development and histological characterization, is essential. Enhancing comprehension of LM-related pathologies is crucial for accurate preoperative planning and optimizing patient outcomes in neurosurgery.
Topics: Humans; Neurosurgical Procedures; History, 20th Century; History, 19th Century; Clinical Relevance
PubMed: 38795689
DOI: 10.1016/j.clineuro.2024.108322 -
World Neurosurgery Feb 2024The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory...
OBJECTIVE
The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date.
METHODS
A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed.
RESULTS
A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08-79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0-15 years].
CONCLUSIONS
Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery.
Topics: Humans; Male; Female; Infant, Newborn; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cerebellopontine Angle; Hearing Loss; Headache; Vertigo; Deafness; Arachnoid Cysts; Ataxia
PubMed: 38070740
DOI: 10.1016/j.wneu.2023.12.018 -
The Spine Journal : Official Journal of... Aug 2023Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long... (Review)
Review
BACKGROUND CONTEXT
Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long rostral-caudal extensions and many are related to arachnoiditis, leading to difficult-to-treat disorders. Thus far, due to the scarcity of reports, the features of the disease and the optimal therapeutic strategies remain unclear.
PURPOSE
To investigate clinical features and the optimal treatment modalities of secondary spinal arachnoid cysts compared with primary spinal arachnoid cysts.
STUDY DESIGN
Systematic review.
PATIENT SAMPLE
Systematic review identified 103 secondary cases from 80 studies and reports.
OUTCOME MEASURES
Condition of symptom relief and duration of treatment response were analyzed.
METHODS
An electronic literature search of the PubMed database was conducted for studies on secondary spinal arachnoid cysts between 1990 and 2022. Non-English publications, nonhuman studies, reports of a primary cyst, studies not including case details, and studies of nonsymptomatic cases were excluded.
RESULTS
This systematic review included 103 secondary cases. The most commonly reported etiologies were iatrogenic factors, trauma, and subarachnoid hemorrhage, accounting for 88 intradural extramedullary, 11 extradural, one intradural/extradural, one interdural, and one intramedullary spinal arachnoid cyst after a median duration of 30, 12, and 9 months, respectively. Extradural cysts were more prone to occur at dorsal locations and affect thoracic segments (mean cyst length: 3.4 segments). Intradural cysts showed a relatively higher ventral/dorsal ratio (1:1.09, 1.75:1, and 3.50:1 for cysts occurring from iatrogenic factors, trauma, and subarachnoid hemorrhage, respectively) and thoracic distribution, with a mean cyst length of 4.3 segments (5.1 for ventral and 3.5 for dorsal cysts). For intradural cysts, recurrence risk was lower after surgical resection than after fenestration/marsupialization (12-month recurrence risk: 21.43% vs 50.72%, log-rank test: p=.0248, Gehan-Breslow-Wilcoxon test: p=.0126). In cases treated with shunting, one recurrence (1/8 cases) was noted after external shunting and two recurrences (2/5 cases) after internal shunting at a median follow up of 12 months.
CONCLUSIONS
Secondary spinal arachnoid cysts, particularly intradural cysts, are rarer and more challenging to treat than primary spinal cysts. Although fenestration/marsupialization is the commonly adopted treatment, the recurrence rate is high. For unresectable cysts, shunting procedures, particularly shunting into a body cavity (eg, pleural or peritoneal cavity) away from the subarachnoid space, could be a therapeutic alternative besides fenestration/marupialization, yet its efficacy requires confirmation by more data.
Topics: Humans; Arachnoid Cysts; Subarachnoid Hemorrhage; Spinal Cord Diseases; Neurosurgical Procedures; Iatrogenic Disease; Magnetic Resonance Imaging
PubMed: 36924909
DOI: 10.1016/j.spinee.2023.03.002