2022 AMI Online Salon

A taxonomy for posterior brainstem cavernous malformations: periaqueductal, inferior cerebellar, and cuneate subtypes

Project Details

  • Entrant Name:  Peter Lawrence
  • Other Contributors: Kristen Larson Keil
    Client: Barrow Neurological Institute
  • Copyright: Barrow Neurological Institute, 2022
  • Medium/software used: Adobe Photoshop, pencil
  • Final presentation format: Print
  • Primary Audience: Resident and attending neurosurgeons

Project Description

We present three sets of illustrations selected from ongoing work describing a novel taxonomy for brainstem cavernous malformations (BSCMs) based on clinical presentation and anatomical location of lesions. Although BSCMs are highly variable in size, shape, and position, they are naturally categorized by location into three types: midbrain, pons, and medulla. Further categorization into subtypes within these regions forms the basis of this new taxonomy. These illustrations provide a comprehensive visual overview of a selected subtype from each region. The top panel features a simplified circuit diagram and cut sections showing the tracts and nuclei affected by the lesion. The patient illustration and accompanying figures bring to life the resulting named syndromes and selected associated symptoms. The bottom panel describes surgical approach considerations including the craniotomy, surgical window, and resulting exposure. Insets along the bottom show “augmented views,” which highlight critical anatomy, anatomical triangles, and deep nuclei in the area. BSCMs are associated with recognizable constellations of neurologic symptoms. Consideration of diversity in ethnicity, age, gender, and body type was top of mind when selecting and illustrating representative “patients” to convey these symptoms, both to increase the presence of underrepresented groups in medical literature and to underscore the wide range of individuals affected by these rare lesions.