Lydia Greg, MA, CMI, FAMI

Ellicott City, Maryland, United States

This illustration depicts motor structures of the brain that may be damaged during insular surgery including the FAT (frontal aslant tract), CST (corticospinal tract), and CBT (corticobulbar tract) pathways. The M2 segments of the MCA branches cover and supply the insula before they extend over the cerebral hemispheres. The two coronal sections on the right show how the long insular artery and the long medullary artery supply the corticospinal and corticobulbar tracts. These crucial branches must remain intact during surgery.

Purpose

This illustration was created to highlight motor structures of the brain that are at risk during insular epilepsy surgery. It was intended for an audience of neurosurgeons. The main image on the left shows retraction of the brain to reveal the insula and the M2 segment of the middle cerebral artery (MCA). The FAT (frontal aslant tract), CST (corticospinal tract), and CBT (corticobulbar tract) motor pathways are revealed through the transparent surface of the brain. Dashed lines in the main image show the locations of the two coronal sections on the right.

Equiment

The linework for the piece was sketched and finalized on a Wacom Cintiq 22. The piece was colorized in Photoshop and created using DICOM references in 3DSlicer.