2022 AMI Online Salon

Recurrent brainstem cavernous malformations following primary resection: blind spots, fine lines, and the right-angle method

Project Details

  • Entrant Name:  Peter Lawrence
  • Other Contributors 
    Mark Schornak
  • Client: Barrow Neurological Institute
  • Copyright: Barrow Neurological Institute, 2021
  • Medium/software used: Adobe Photoshop, pencil
  • Final presentation format: Print
  • Primary Audience: Resident and attending neurosurgeons, medical students

Project Description

The proximity of brainstem cavernous malformations (BSCMs) to tracts and cranial nerve nuclei makes it costly to disrupt normal tissue adjacent to the lesion in the separation plane. This interplay between tissue sensitivity and extreme eloquence makes it difficult to avoid leaving a remnant. Recurrences require operative intervention, which may increase morbidity, lengthen recovery, and add to overall costs. It is essential that neurosurgeons understand factors that lead to decreased visualization and “blind spots” which can conceal remnants, such as small keyhole surgical openings, long corridors which can limit viewing angles, and sharp right-angles in the lesion beds. This illustration works to illuminate the anatomy of the blind spot by depicting an impossible view of the neurosurgical corridor and emphasizing how limited the visibility within the resection cavity can be. By understanding the anatomy of the blind spot and implementing a right-angle method of resection, fewer vestigial cavernomas will be left in patients, leading to quicker recoveries, less recurring lesions, and better quality of life.