Professional Documents
Culture Documents
Edited by
Andy Shores
Clinical Professor and Chief, Neurosurgery and Neurology
Mississippi State University College of Veterinary Medicine
The Veterinary Specialty Center
Mississippi State, Starkville, MS, USA
Brigitte A. Brisson
Professor of Small Animal Surgery
Department of Clinical Studies
Ontario Veterinary College
University of Guelph
Guelph, Ontario, Canada
This edition first published 2023
© 2023 John Wiley & Sons, Inc.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material
from this title is available at http://www.wiley.com/go/permissions.
The right of Andy Shores and Brigitte A. Brisson to be identified as the authors of the editorial material in this work has been asserted in
accordance with law.
Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions
of this book may not be available in other formats.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United
States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners.
John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should
not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of
ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of
medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for
each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and
precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with
respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any
implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written
sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation
and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization,
website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged
in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a
specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when
this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages,
including but not limited to special, incidental, consequential, or other damages.
Contents
Radiobiology 25
DNA as The Target for Radiation 25
Normal Tissue Injury 26
Rationale for Radiation Fractionation 26
Radiation Physics and Treatment Planning 28
Beam Energy Selection 28
Dose Calculations 28
Target Localization Strategies 29
Delivery Systems 31
Plan Evaluation 32
Specific Tumor Types 33
Meningioma 33
Clinical Data 33
Radiotherapeutic Techniques 34
Glial Tumors 34
Clinical Data 34
Radiotherapeutic Techniques 35
Choroid Plexus Tumors 35
Clinical Data 35
Radiotherapeutic Techniques 35
Spinal Tumors 35
Clinical Data 35
Radiotherapeutic Techniques 36
Stereotactic Radiosurgery and Stereotactic Radiation Therapy 36
References 37
Foraminotomy 136
Facetectomy 137
Distraction, Fusion, and Stabilization 137
Pins and PMMA 137
SOP Plating 137
Surgical Technique 138
Pedicle Screw and Rod Fixation (PSRF) 138
Minimally-Invasive Transilial Vertebral (MTV) Blocking 138
Postoperative Management 139
References 139
Vessels 163
Nerves 163
Viscera 163
Surgical Technique [10, 12] 163
Clinical Results 165
Conclusion 167
References 167
21 Surgical Management and Intraoperative Strategies for Tumors of the Skull 211
Jonathan F. McAnulty
Osteosarcoma and Multilobular Osteochrondrosarcoma of the Cranium 211
Diagnosis and Characterization 212
Surgical Planning and Treatment 212
Exposure 212
Challenges in Skull Tumor Resection 214
Parietal Calvarial and Dorsal Frontal Bone Lesions 214
Frontal Bone within the Orbit and Sphenoid Bone Lesions 215
Occipital Bone Lesions 215
MRI Assessment of Blood Flow to the Transverse Sinuses 216
Slow Occlusion of Flow from the DSS to the Transverse Sinus Using a Balloon Catheter 217
Extension of Tumor to the tentorium Cerebelli 218
Zygomatic Arch and Ramus of the Mandible 218
Complications and Risks 219
Cranioplasty 220
References 221
Technique 235
Closure 236
Meningioma Resection and Instrumentation 236
Simpson Classification of Meningioma Resection in Humans (Table 22.2) 237
Substitutes for Resected Dura Mater 237
Complications and Mitigation Strategies 239
References 239
Index 269
xvii
List of Contributors
ACVS Foreword
The American College of Veterinary Surgeons Foundation direction for residents in training as well as surgeons
is pleased to present Advanced Techniques in Canine and already employing neurosurgical procedures in their
Feline Neurosurgery in the book series entitled Advances in practices.
Veterinary Surgery. Advanced Techniques in Canine and Feline Neurosurgery
The ACVS Foundation is an independently charted phil- is edited by Drs. Andy Shores and Brigitte Brisson. I’d like
anthropic organization that supports the advancement of to congratulate and thank them for helping to move this
surgical care of all animals through funding of educational fast‐growing field forward. They have chosen an interna-
and research opportunities for veterinary surgical residents tional group of strong contributing authors to cover canine
and board‐certified veterinary surgeons. and feline neurosurgical skills, equipment, techniques,
Our collaboration with Wiley Publishing Company and procedures. I am sure you will find this reference
brings unique contributions that can benefit and enhance extremely valuable.
the learning process to all interested in veterinary surgery. The ACVS Foundation is proud to collaborate with Wiley
One of the key missions of the ACVS Foundation is to in this important series and is honored to present this new-
promote innovative education for residents in training and est book in the Advances in Veterinary Surgery series.
diplomates. This book underscores our intent, focusing on
achievements made by scientists, their latest key findings, R. Reid Hanson, DVM, ACVS, ACVECC
along with new techniques made possible by state‐of‐the‐ Chair, Board of Trustees
art equipment. This book will inspire, inform, and provide ACVS Foundation
xxi
ACVIM Foreword
It is my pleasure on behalf of the ACVIM to introduce paved the way to our learning and understanding of veteri-
the book, Advanced Techniques in Canine and Feline nary neurosurgery and let us not forget those who led us
Neurosurgery, edited by Drs. Andy Shores and Brigitte in our neurosurgical training. Trainees and their mentors
Brisson. The content provided includes basic and will utilize this textbook as a comprehensive guide, which
advanced knowledge of veterinary neurosurgery shared provides accurate and concise information of neurosur-
by many who are ACVS, ACVIM, and ECVN trained. The gery. The videos on the website also are a valuable resource
information is practical and focuses on techniques that and innovative way to demonstrate techniques and proce-
are directly applicable and relevant to practice of neuro- dures. This dynamic resource enables visual learning on
surgery. Veterinary neurosurgery continues to grow and another scale.
certainly has reached an area of expertise in our profes- My colleagues who have contributed to this textbook are
sion. Our veterinary patients must have access to neuro- to be commended on their efforts especially during a pan-
surgeons who are experts in the most current surgical demic that posed many challenges. It is because of their
techniques. time and talents, and those of our fellow ACVIM
The neurosurgical topics are comprehensive and bring Diplomates, that ACVIM is able to continually advance our
forth new techniques and technologies in performing spi- mission to be the trusted leader in veterinary education,
nal and intracranial procedures. Neurosurgery will be for- discovery, and medical excellence.
ever evolving as we adopt human neurosurgical principles
and procedures into veterinary medicine. Of special note Joan R. Coates, DVM, MS, DACVIM (Neurology)
is the chapter on the history of neurosurgery. Many have ACVIM Neurology Specialty President
xxiii
Preface
The interest of many and the many advancements in the should and will come with time: the ABVS should give
field of veterinary neurosurgery prompted the develop- strong consideration to the development of a separate spe-
ment of this book. And while some routine or standard cialty or a sub‐pecialty.
approaches are included in these chapters, much of the This book contains many spinal and intracranial proce-
content is devoted to advanced techniques being performed dures, several of those (such as the surgical management
by many of the top veterinary neurosurgeons in the world. of sellar masses) are on the cutting edge of our discipline.
Some are ACVS trained, some are ACVIM (Neurology) or I am very grateful for the many hours my colleagues have
ECVN trained, but we share the same vocation: veterinary put into these works and they are well deserving of my
neurosurgery. Veterinary neurosurgery continues to grow heartfelt thanks. In the midst of a pandemic, these col-
and certainly has reached a point of being a very important leagues came through with outstanding works.
subspecialty in our profession. The hours of training and I trust the readers will benefit from the content and espe-
devotion to this discipline by my fellow neurosurgeons is cially from the number of accompanying videos on the
noteworthy and certainly deserving of formal recognition website.
for what it has become – its own entity. And while I do not I sincerely appreciate the tremendous effort put forth by
expect a major change in my lifetime, I sincerely hope this my colleagues that contributed to this volume.
work will foster the continued development of our subspe-
cialty by the many fine individuals currently engaged and Andy Shores
for those to come. As such, I believe formal recognition Mississippi State, MS, USA 2023
xxv
http://www.wiley.com/go/shores/advanced
Video 17.1 Video showing the integrity of the mediastinum in a cadaveric model in which median manubriotomy has
been performed and 200 ml of air injected into the thoracic cavity through a catheter. The video shows an
expansion of the pleura without any evident leak in the cranial mediastinum.
Video 18.1 This video depicts the use of intraoperative ultrasound in the removal of a supratentorial mass in a canine
patient.
Video 19.1 Video demonstrating a brain biopsy procedure using the BrainsightTM Frameless Stereotactic Biopsy Device.
Video 20.1 Video depicting a transshphenoidal hypophysectomy in an 8 year‐old female/spayed mixed breed dog.
Video 21.1 Guidelines for surgical management of tumors of the Canine Skull.
Video 22.1 This video demonstrates the Purdue Diamond transfrontal craniotomy.
Video 22.2 Exposure of the olfactory bulbs using the Purdue Diamond frontal craniotomy approach.
Video 22.3 Video of the removal of a cerebellar meningioma using traction in a cat through a suboccipital craniectomy.
Video 23.1 Lateral ventricular fenestration.
Video 24.1 This video depicts a 4th Ventricular Mass Excision via Occipital Craniectomy in a live patient.
Video 25.1 Demonstration of the Transzygomatic Approach in a Cadaver.
1
Advanced Techniques in Canine and Feline Neurosurgery, First Edition. Edited by Andy Shores and Brigitte A. Brisson.
© 2023 John Wiley & Sons, Inc. Published 2023 by John Wiley & Sons, Inc.
Companion site: www.wiley.com/go/shores/advanced
2 Advanced Techniques in Canine and Feline Neurosurgery
in humans using the non‐ionic, biologically inert contrast Advances in Spinal Procedures
agent metrizamide (Amipaque® ) were reported [14].
Metrizamide and other non‐ionic contrast medias were
Thoracolumbar (T1–S1)
also found to be of value for the confirmation of various
spinal cord diseases in veterinary patients and were used The vast majority of the veterinary publications that
extensively until the advent of diagnostic CT and MRI. chronicle surgery of the thoracolumbar spine involved
Advances in imaging techniques of the skull and brain of degenerative disk disease. However, Olsson [6] and
animals followed a pattern similar to spinal studies. Early Vaughn [30], both notable early authors, regarded both
reports utilizing plain film radiographs of the skull empha- hemilaminectomy and laminectomy too hazardous a sur-
sized the importance of head position to achieve precise gical procedure to be recommended as a treatment for disk
symmetry [5], the most essential criterion for interpreta- protrusion in the dog. These authors observed dogs with
tion of brain and skull radiographs [15]. While these early spinal cord injury from a ruptured disk could recover
radiographic methods were typically adequate to confirm without surgery and theorized it imprudent to risk a
bony lesions, they were inadequate to confirm most intrac- potential permanent surgically induced spinal cord dam-
ranial forms of pathology. Several early investiga- age in dog that may recover without surgery. In 1951,
tors [16–19] experimented with various head positions, Olsson recommended a dorsolateral approach for disk fen-
contrast agents, and injection techniques for cerebral angi- estration but not “intervention into the vertebral canal”
ography and venography; however, these images were dif- for dogs with disk protrusion, ascribing the reduced risk of
ficult to interpret because of imprecise head positioning injury to the nerves and spinal cord and prophylaxis as
and consistent variations in vessel patterns. In 1961, benefits of fenestration. After Olsson’s report, multiple
Hoerlein and Petty [20] and Cobb [21] published articles fenestration procedures were proposed for the dog. In
describing pneumoencephalography in dogs. Again, posi- 1971 Leonard [31] proposed ventral fenestration; in 1969
tioning difficulties and filing artifacts made clinical appli- Ross [32] and in 1965 Northway [33] each proposed vent-
cation uncommon. In his 1961 article, Hoerlein [20] rolateral fenestration; in 1968 Hoerlein [34], in 1975
reported the result of injection of air or opaque medium Flo [35] and in 1973 Yturraspe [36] proposed dorsolateral
into one or both lateral ventricles and concluded that “ven- fenestration; in 1968 Seemann [37] proposed a lateral
triculography in clinical practice is of value in demonstrat- muscle separation approaches for disk fenestration and in
ing either unilateral or bilateral ventricular dropsy as well 1976 Braund et al. [38] proposed a lateral approach for
as a space‐occupying lesions.” both spinal decompression and disk fenestration.
All of the neuroradiographic techniques previously dis- Numerous neurosurgeons differed with Olsson and
cussed are restricted by their invasive nature, inconsistent Vaughn regarding the prohibition of spinal cord decom-
reproducibility, limited visualization of the pathologic pressive procedures for disk disease. Although reports of
lesion, and undesirable morbidity and mortality. Before disk protrusion creating neurologic disability in dogs was
the 1980s most veterinary neurosurgeons experienced recognized as early as 1913 [39], the introduction of mye-
frustration dealing with these restrictions. To the relief of lography in the early 1950s heralded the use of hemilami-
the veterinary neurosurgeon and to the benefit of the ani- nectomy and laminectomy for the treatment of
mal patient and their owners, a remedy to the earlier intervertebral disk protrusion. In 1951, Greene [10] at
restrictions was found in CT and MRI technology. The Alabama Polytechnic Institute (later Auburn University)
principles of computed tomography were first elucidated described a dorsolateral approach for a hemilaminectomy
by Hounsfield in 1973 [22] and the first clinical report of (Figure 1.1). Also, in 1951, Redding [40] at the University
CT application in veterinary medicine was published in of California Davis published a laminectomy technique
1980 by Marineck and Young [23] followed in 1981 by that he originally developed at Ohio State University
LeCouter et al. [24]. Interestingly, both reports involved (Figure 1.2). In 1956, Hoerlein [41] at Auburn University
canine patients with neoplasia of the CNS. Although the reported the benefits of dorsolateral hemilaminectomy
theory of nuclear magnetic resonance (NMR) was first with prophylactic fenestration that he originally worked on
advanced in the 1950s [25], MRI technology became clini- at Cornell (Figure 1.3). Interestingly, by the mid‐1950s,
cally relevant in the 1970s following the development of a Greene et al., all surgical pioneers, were actively engaged
mechanism of encoding spatial information from NMR in the field of neurology and neurosurgery at Auburn
data [26]. Veterinary reports involving MRI studies of the University. In 1976 [42] and again in 1977 [43], Swaim at
canine head and brain first appeared in the 1980s [27, 28] Auburn University published on the use of bilateral hemi-
with clinical reports of spinal disease occurring in the laminectomy for extensive spinal cord decompression
1990s [29]. (Figure 1.4).
1 A History of Veterinary Neurosurgery: 1900–2000 3
stabilizing L7 dislocations. Dulisch and Nichols at the management of intervertebral disk disease. Workers
Michigan State University [62] modified the transilial tech- strived to develop procedures that were less invasive and
nique by combining plastic plates affixed to the spinous removed less bone, thus preserving vertebral stability and
processes rostral to the fracture‐dislocation with two tran- improving postoperative recovery as compared to laminec-
silial pins that pass through holes in the plates. To mitigate tomy and hemilaminectomy. These modifications included
pin migration, Ullman and Boudrieau [63] at Tufts accessing the spinal canal by creating an opening in the
University used crossed transilial Steinmann pins con- pedicle, the vertical segment of bone that emanates from
nected by double Kirschner clamps. McAnulty et al. [64] at the body of the vertebra; such an operation has been
the University of Pennsylvania proposed a modified seg- termed a pediculectomy. When the pedicle and articular
mental spinal instrumentation technique utilizing multi- process is removed, the operation has been termed a mini‐
ple Steinmann pins on either side of the spinous processes. hemilaminectomy. In 1976, Braund et al. [38] in Sydney
The pins were initially advanced through the ilial wing and and Auburn devised a lateral muscular approach to the
then bent 90° and wired to the articular processes and dor- thoracolumbar spine with removal of the bony pedicle and
sal spinous processes rostral to the fracture site. Shores accessory process without involvement of the articular pro-
et al. [65] at Michigan State University combined Kirschner‐ cess or lamina. In 1986, Bietto and Thatcher [69] at the
Ehmer external fixator apparatus with internal dorsal spi- AMCNY, published a modification of Braund’s lateral tech-
nal plate fixation for the repair of caudal lumbar fractures. nique that accesses the spine utilizing a dorsolateral mus-
This technique provided rigid fixation of the fracture site, cle separation approach. In 1997, McCartney [70] described
allowed decompression procedure, and could be used in a partial pediculectomy technique that allows access to the
dogs with fractures of the spinous and articular processes. ventral aspect of the spinal canal with preservation of
Compared to the thoracolumbar spine, the lumbosacral accessory process and the diarthrodial joint. In the appro-
(LS) region has other unique pathologic distinctions. The priate cases, this procedure provides adequate access for
L7–S1 disk space must accommodate the biomechanical retrieving ventrally or laterally displaced disk material
forces attendant to the relative mobile L7 vertebra and the while reducing surgical morbidity.
nearly immobile sacral vertebra. These forces typically con-
verge at the intervertebral disk, the diarthrodial joint, and
Cervical (C1–C7)
associated soft tissues. Over time, these forces can result in
degenerative changes in the disk, joint capsule, ligamentum Cervical disk disease is a well‐recognized clinical condition
flavum, and diarthrodial joint producing stenosis that com- of dogs. In the 1950s workers [6, 71] suggested that the
presses the associated neural elements. Before the advent of treatment of choice to manage dogs with cervical pain
CT and MRI, clinicians could only confirm LS pathology from intervertebral disk disease was a ventral disk fenestra-
with plain film radiographs, myelography, epidurography, tion. In cases involving motor deficits, more aggressive
or interosseous venography; regrettably, radiographic find- techniques were suggested. In 1962, Funkquist [72] pub-
ings in these cases were usually inconclusive. Consequently, lished a dorsal laminectomy technique for cervical disk
most of the early surgical procedures were devised as all‐ protrusion in the dog. Also in 1962, Hoerlein [73] reported
purpose procedures designed to decompress the nervous on dorsal cervical laminectomy and hemilaminectomy sur-
tissues and to stabilize the LS joint. In 1978, Oliver et al. at gical techniques. Although initially these dorsal decom-
the University of Georgia [66] proposed that the LS region pressive approaches were considered methods of choice to
pathology was akin to the malarticulation‐malformation manage dogs with cervical disk disease, the intensive
pathology noted in the caudal cervical region of Doberman immediate postoperative care attendant to recovery
Pinschers and described a dorsal laminectomy for decom- demanded a less invasive technique. The ventral decom-
pression of the cauda equine and removal of disk prolapse pression procedure is far less traumatic and achieves
and attendant fibrous adhesions. A foraminotomy was pre- decompression by removal of the offending disk mass. In
scribed for L7 nerve root entrapment. Tarvin and Prata [67] 1971, Popovich [74] at Walter Reed Army institute of
at the AMCNY endorsed a dorsal laminectomy and bilateral Research modified Cloward’s [75] fusion technique for sur-
facetectomies/foraminotomies for LS stenosis. Slocum and gical management of cervical disk disease in humans with
Devine [68] advocated distraction of the LS joint with a pin a ventral trephination centered over the disk space and ver-
fixation technique that incorporated a corticocancellous tebral body fusion using a slightly oversized autogenous
bone graft harvested from the wings of the ilia for manage- bone dowel placed in the trephination hole. In 1973,
ment of cauda equina compression. Swaim [76] reported on a ventral midline spondylectomy
Over time, advances in imaging technology promoted and diskectomy (slot technique) that he developed while at
refinement of most spinal techniques but most notably for Auburn University. Swaim’s technique did not employ a
6 Advanced Techniques in Canine and Feline Neurosurgery
bone graft. Also, in 1973, Prata and Stoll [77], concerned trauma in any animal. Initially, dorsal exposure of the
about the need to stabilize the surgical site, employed occiput, axis, and atlas was the surgical approach recom-
Swaim’s technique with the addition of an autogenous iliac mended for remedy of AIS. In 1967, Geary et al. [84] at
bone graft. Cornell University, and in 1970, Gage and Smallwood [85]
Although the ventral approach was considered preferen- at Texas A&M University (Figure 1.7), described a dorsal
tial to the dorsal approach for the management of most approach used to tether the atlas to the axis with a single
cases of cervical disk disease, a dispute occurred among strand of orthopedic wire passed under the atlas then
neurosurgeons regarding the need to stabilize the surgical looped back over the top of the atlas and tied to its mate
site. In 1976, Gilpin [78] reported on three different ventral that has been inserted into a hole drilled in the spine of the
slot techniques in normal dogs. In Gilpin’s experiment, axis; a hemilaminectomy was recommended in cases that
three dogs received a contiguous slot that extended over required spinal cord decompression. Geary’s original tech-
two intervertebral disk spaces and one‐third of a vertebral nique has been modified by various workers. In 1973,
width; three dogs received a slot that extended over one Oliver and Lewis [86] at Purdue University proposed using
intervertebral disk space and the full‐width of the ventral a loop of wire passed ventral to the atlas that when cut and
vertebral body; and three dogs received a contiguous slot tied individually through two holes in the axis formed a
that extended over two intervertebral disk spaces and the “saddle type” configuration. In 1977, Chambers et al. [87]
full‐width of the ventral vertebral body. All dogs had a nor- at the University of Georgia recommended replacing wire
mal recovery save two of three dogs in the third group that with non‐metallic suture material because of the high fre-
experienced mild postoperative pain. Gilpin’s work pro- quency of postoperative wire breakage and the difficulty of
vided a sound and secure basis of support for Swaim’s tech- passing large gauge wire in the relatively small epidural
nique as the treatment of choice for the management of space that exists under the atlas of small dogs. In 1979,
cervical disk disease in the dog. In 1991, Goring et al. [79] Renegar and Stoll [88] at the University of Missouri,
at the University of Florida modified the traditional ventral described incorporating MMA with the dorsal wire tech-
slot for treating Doberman Pinschers with cervical verte- nique in a dog where wires placed earlier had cut through
bral instability by laterally expanding the slot boundary the dorsal arch of the atlas. In 1980, LeCouter et al. [89] at
adjacent to the spinal canal, creating a decompression win- the University of Guelph advocated for using the nuchal
dow that resembles an inverted cone. These authors sug- ligament as a means of securing the spinous process of the
gest that this modification allows for a more expansive axis to the dorsal arch of the atlas. These authors used this
decompression at the site of disk compression while mini- technique with success in one of two toy‐breeds with AIS
mizing collapse of the disk space that could lead to postop- and two larger dogs with fracture of the axis. In 1984,
erative nerve root entrapment. Kishigami [90] in Osaka, Japan developed a custom‐made
However, in some animals, the offending disk pathology tension band retractor with a lip that fitted under the
requires the neurosurgeon to provide an expansive decom-
pression of the spinal cord. In 1963, Pettit and Whittaker [80]
at Washington State University published a dorsal approach
for a hemilaminectomy as a means to manage a dog with a
cervical disk protrusion. In 1973, Parker [81] at the
University of Illinois reported on a dorsal approach to the
cervicothoracic junction for the purpose of a dorsal lami-
nectomy. In 1983, Felts and Prata [82] at the AMCNY pub-
lished on the dorsal approach for hemilaminectomy and
facetectomy for intraforaminal and lateral disk extrusions.
1992, Lipsitz and Bailey [83] at the University of California
described a hemilaminectomy/facetectomy that extended
from the base of the spinous process to near the floor of the
spinal canal. These authors recommended this approach
for decompression and removal of lateral masses and for
nerve root exploration; sites less accessible by either the
ventral or dorsal cervical approach.
Atlantoaxial instability/subluxation (AIS) is a relatively
Figure 1.7 Dr Dean (pictured here at Texas A&M University in
common disorder noted largely in young toy‐breed dogs 2016). Dr Gage and Hoerlein published several papers
but can occur in larger dogs and can be associated with describing techniques to repair spinal fractures and luxations.
1 A History of Veterinary Neurosurgery: 1900–2000 7
rostral arch of the atlas and two legs that extended caudally fusion for prominent craniodorsal projection of the verte-
on either side of the axis which accepted a wire suture that bral body, with or without unstable malarticulation. In
was crisscrossed through holes in the axis. The author 1985, Lincoln and Pettit [102] at Washington State
reported success in one cat and four dogs with AIS. In 1996, University reported on 17 large dogs treated solely with
Jeffery [91] at the Animal Health Trust, Newmarket, disk fenestration and concluded that disk fenestration
Suffolk, used Steinmann pins inserted through one side of alone provided inadequate treatment for CVMMS. Following
the spine of the axis into the wing of the atlas on the oppo- Lincoln’s report, in 1988, Ellison et al. [103] at the
site side. This crossing configuration was used in conjunc- University of Florida reported on a distraction‐fusion tech-
tion with a cancellous bone graft and MMA fixation. nique designed to help resolve the inadequacies of stan-
Numerous postoperative complications have been dalone fenestration. Ellison technique utilized a cancellous
reported when utilizing any of the various iterations of the bone graft for fusion and cancellous bone screws and MMA
dorsal repair for ASI. To redress these concerns, Sorjonen for stabilization. In 1989, Bruecker et al. [104] at Colorado
and Shires [92] at Auburn University reported on a ventral State University reported on a modification of Ellison’s
surgical technique for decompression, fixation, and fusion technique using Steinmann pins and MMA. In 1990,
of atlantoaxial instability. Their technique accomplished McKee et al [105] at the University of Melbourne reported
spinal cord decompression by odontoidectomy and boney on the use of two orthopedic washers inserted into the disk
alignment, with pin fixation for stabilization and cancel- space for distraction and a cancellous bone screw advanced
lous bone graft for fusion. The ventral technique has also from the cranial vertebra through the intradiskal washers
been recommended by various workers [93–95] with modi- and into the caudal vertebra for fusion. In 1991, Goring
fications that include lag screw fixation [93], Steinmann et al. [79] introduced the inverted cone decompression
pins and MMA fixation [94], bone plating, and cannulated technique to provide maximal spinal cord decompression
screw fixation with cancellous graft fusion [95]. with reduced intra‐ and postoperative morbidity. In 1991,
Caudal vertebral malformation‐malarticulation syn- Lyman [106] published a report originally presented in
drome (CVMMS) is a condition that affects both large‐ and 1987, proposing a dorsal laminectomy that extends from
small‐breed dogs. In 1971, de Lahunta [96] at Cornell C5 through C7. Lyman stated that his “continuous dorsal
University described the neurologic, radiographic, and laminectomy procedure offers the best chance for defini-
pathologic features in young rapidly growing Great Dane tive management and long‐term survival with a good qual-
dogs and suggested naming the syndrome Wobbler because ity of life in Doberman Pinschers with CVMMS.”
of the ataxic and paretic gait common to these dogs. Since The abundance of surgical options for repair of CVMMS
then, Wobbler Syndrome has been reported by numerous suggest that one remedy cannot be applied to all cases.
names (cervical vertebral instability, cervical spondylomy- While most neurosurgeons select their technique based on
elopathy, cervical spondylolisthesis, and cervical spondy- the needs of the animal patient, cervical distraction and
lopathy) and purported surgical remedies. In 1972, Gage stabilization has become increasingly popular for the treat-
and Hall [97] reported a successful repair of C6–7 subluxa- ment of CVMMS.
tion with a hemilaminectomy for decompression and Cervical fractures and dislocations occur less frequently
Auburn spinal plate for fixation. In 1973, Dueland et al. [98] than thoracolumbar fractures/dislocations [107]; perhaps a
at the University of Saskatchewan reported on a dorsal benefit of the more robust cervical musculature or greater
laminectomy with bone graft and articular wiring tech- mobility of the cervical vertebrae [108]. The atlantoaxial
nique. Also in 1973, Gage and Hoerlein [99] advocated fen- region is the most common reported site of fracture/dislo-
estration with interbody lag screw stabilization. In 1975, cation pathology. In 1958, Hoerlein [109] reported a suc-
Swaim [100] evaluated four techniques for cervical spinal cessful repair of a fractured axis using a plate on the
fixation in dogs with mid‐ and caudal‐cervical vertebral spinous process. In 1968, Gage [108] reported on a repair of
instability and concluded that bilateral screws through the a fractured atlas, axis, and odontoid process using a hemi-
articular processes provided the most solid fixation. In laminectomy for decompression and wiring of the atlanto-
1976, Trotter et al. [101] published a comprehensive 10‐ axial joint for stabilization. In 1969, Gendreau and
year review of cases at Cornell University and concluded Cawley [110] at the University of Guelph reported the suc-
that no one surgical technique could be recommended for cessful repair of a fracture of the axis in two dogs using two
all cases. They proposed a dorsal laminectomy for stenotic plates affixed to either side of the ventral midline of C2. In
cranial orifice of a vertebral foramen or with a stable malar- 1979, Rouse [111], concerned about screw penetration into
ticulation; a laminectomy with arthrodesis for stenotic cra- the spinal canal when used to affix a ventral body plate,
nial orifice and an unstable malarticulation or unstable reported on the repair of the axis using Steinmann pins
malarticulation alone; and ventral decompression with that were placed tangential to the spinal canal then
8 Advanced Techniques in Canine and Feline Neurosurgery
stabilized using MMA. In 1986, Basinger et al. [112] at the Markowitz and Archibald [123] at the University of
University of Georgia reported on the entrapment of the Ontario, in 1961 Alvarez‐Buylla et al. [124] at the
cranial articular process of C6 over the caudal articular University of Colima, Henry et al. [125] at Louisiana State
process of C5 resulting from a dog fight in two poodles. University, and in 1988 Niebauer and Evans [126] at the
Cervical vertebral hyperflexion with rotation was proposed University of Pennsylvania all reported on various
as a mechanism for the pathology. The subluxation was approaches for hypophysectomy in the dog. Markowitz,
mechanically reduced and stabilized using two lag screws Alvarez‐Buylla, and Henry relied on the intrasphenoid
through the articular processes. In 1997, Boudrieau [113] suture, the emissary vein, and the hamulate process as
at Tufts University reported on the successful repair of axis intraoperative anatomic landmarks to help determine the
fractures in three dogs using the Scoville‐Haverfield lami- correct site to create the ostectomy that facilitated the
nectomy retractor for fracture reduction and a screw‐MMA hypophysectomy. Niebauer utilized three witness screws
construct for stabilization. Interestingly, in 1999, placed in the sphenoid bone followed by a cranial sinus
Hawthorne et al. [114] at Purdue University, concerned venogram to outline the cavernous sinus that surrounded
about an observation of high perioperative mortality asso- the hypophysis. All four authors recorded successful hypo-
ciated with cervical spinal surgery in dogs with cervical physectomies utilizing their techniques. Meij [127] in
fractures, advocated for cage rest with external support in 1998, at Utrecht University, was the first to utilize CT to
animals with cervical fractures (unstable or displaced) enable accurate assessment of the pituitary size and loca-
unless the neurological signs are progressive. tion relative to intraoperative anatomic landmarks.
Finally, one extraordinary case report deserves attention.
In 1965, Oliver [128] at Auburn University published a
Advances in Intracranial Procedures report of an emergency rostrotentorial craniotomy in a
Boxer dog with seizures. The only available preoperative
Intracranial surgery is the sector of veterinary neurosur- workup was a partial neurologic examination; based on a
gery that has profited the most from advances in imaging slow direct and consensual pupillary light response in the
technology. Prior to the advent of CT and MRI imaging, right eye, a right‐sided craniotomy was performed. At sur-
brain surgery was relegated to experimental studies and to gery, two 4 by 2 mm abnormalities were noted, one on the
animals with pathologic conditions that could be deter- surface in the occipital region and the other in the frontal
mined without the aid of sophisticated radiological tech- area. A liquid‐like material was suctioned from both
niques. Consequently, early veterinary surgery textbooks lesions. Subsequently, exposure of the left cerebrum in a
were limited to descriptions of pathology like skull frac- similar operative manner as the right showed no abnormal
tures that could be confirmed by routine radiological tech- findings. The dog was discharged on the twelfth postopera-
niques [115, 116]. Remarkably, some bold early workers tive day. Oliver’s report serves to illustrates the boldness of
relied on knowledge of neuroanatomy and neurophysiol- some early veterinary neurosurgeons.
ogy to develop new intracranial surgical procedures. In In the vast majority of clinical cases with intracranial
1956, Andersson [117] at Veterinarhogskolan, Stockholm, pathology, an accurate antemortem lesion localization is a
Sweden reported the successful treatment of canine dis- prerequisite for a successful surgical outcome. Following
temper with prefrontal lobectomy. In 1972, Redding [118] the development of cerebral arteriography, ventriculogra-
at Auburn University and Allen et al. [119] at Cornell phy, and pneumoencephalography in the early 1960s, some
University reported successful management of aggression veterinary neurosurgeons were incentivized to develop
in dogs with prefrontal lobotomy. In 1982, Hart [120] at intracranial procedures that could offer a surgical remedy
the University of California reported on the successful use for animals with various intracranial pathologies not
of olfactory tractotomy in cats using a frontal sinus amendable to medical treatment. These early reports
approach. In all cases, these authors used easily palpable focused on surgical approaches to the brain and were a dis-
external landmarks to guide their entrance into the cranial tillation of intracranial procedure used in human with
vault. Hydrocephalus is another clinical condition that similar brain pathology. In 1963, Hoerlein et al. [129] pub-
early neurosurgeons were able to manage after confirming lished the first comprehensive report on brain surgery in
their diagnosis by plain film radiographs, angiograms, and the dog. In their treatise, the authors addressed pre‐ and
contrast ventriculograms. In 1966 Few [121] and in postoperative animal husbandry requirements, manage-
1968 Gage and Hoerlein [122], both at Auburn University, ment of brain edema with various hypertonic solutions, the
reported on the successful treatment of hydrocephalus in value of intraoperative hypothermia, anticonvulsants for
dogs with a ventriculoatrial shunt (Holter ventriculo‐caval seizures, preoperative sedative medications, cerebral spi-
shunt valve, type B, Holter Co, Bridgeport, PA). In 1956, nal fluid withdrawal to relieve intracranial pressure (ICP),
1 A History of Veterinary Neurosurgery: 1900–2000 9
proper selection of anesthetic agents, proper patient posi- quick anatomical reference prior to or during brain sur-
tioning, and provided an extensive list of surgical equip- gery. In 1982, de Wet [134] published a comprehensive
ment needed for successful intracranial surgery. Unilateral work that included instrumentation, preoperative, opera-
and bilateral dorsal craniotomy and a cerebellar approach tive, and postoperative details for a radical transfrontal cra-
were described in detail. While these approaches were per- niotomy to access the rostral cranial fossa in dogs.
formed largely in experimental dogs, the authors had the In the decade following the work of Hoerlein et al. and
foresight to envision their use in animals with brain hem- others describing approaches to the brain of dogs, reports
orrhages, abscesses, meningiomas, cysts, and skull frac- of successful surgical application of these techniques to
tures. In 1968, Oliver [130] reported on five surgical manage intracranial pathology began to emerge. In 1971,
approaches that were developed as part of his master’s Parker and Cunningham [135] reported the successful
study at Auburn University (Figure 1.8). Oliver proposed a surgical removal of an epileptogenic focus caused by an
lateral rostrotentorial craniotomy for access to the parietal Aspergillus infection of the frontal sinus and frontal cor-
lobe, occipital lobe, lateral ventricle, and pituitary gland; tex by a transfrontal craniotomy. In 1972, Bagedda [136]
bilateral rostrotentorial craniotomy for access to both sides at the University of Sassari published a report detailing
of the cerebrum and the third ventricle; suboccipital cau- the successful management of a depressed skull fracture
dotentorial craniotomy for access to the cerebellum and in a puppy by a rostrotentorial craniotomy. Both reports
fourth ventricle; rostrotentorial‐caudotentorial craniotomy confirmed the lesion localization by plain film radio-
for access to the anterior cerebellum; and an oral approach graphs. However, in the 1980s and 1990s, following the
to the pituitary gland, pons, and medulla and a ventral cer- advent of CT and MR imaging in veterinary medicine,
vical approach to the pons and medulla. A total of 50 crani- workers had accrued sufficient surgical expertise and case
otomies were performed of which 41 dogs survived from 11 material regarding brain surgery to publish retrospective
to 322 days. In 1972, Parker [131] published a technique for reviews. In 1987, Kostolich and Dulisch [137] at Tufts
transfrontal craniotomy. The report emphasized the impor- University reported on transfrontal craniotomy in four
tance of a watertight dural seal and the need to replace and dogs with meningiomas of the olfactory bulb. In 1991,
stabilize the outer table of the frontal bone in such a way as Niebauer et al. [137] reported an evaluation of craniot-
to avoid compression of the frontal cerebral cortex. By omy procedures in 26 dogs and 5 cats. These authors
1973, reports describing approaches to the canine brain stated that “owing to the advent of refined diagnostic
were no longer considered peculiar. Swaim [132] described tools, brain surgery in pet animals has become more prac-
the use of cutting burs, spherical burs, an oscillating saw, tical” and “these new tools have made available for sur-
and a craniotome to create bone flaps for rostrotentorial, gery a fair number of dogs and cats, with intracranial
caudotentorial, and paracranial approaches. In 1977, de neoplasia, that otherwise would have undergone pallia-
Wet et al. [133] at Ohio State University presented informa- tive treatment (corticosteroids, phenobarbital) alone or
tion regarding the relationship of intracranial brain struc- would have been euthanatized.” Similarly, in 1993, Jeffery
tures to the various types of skulls in dogs to serve as a and Brearley [138] reported on the successful surgical
treatment of brain tumors in 10 dogs and concluded that
“successful control of canine meningioma can be achieved
by surgery plus radiotherapy” but cautioned that “the
optimal therapy for intra‐axial tumors has also yet to be
determined.”
To attend to the surgical management concerns regard-
ing dogs with intra‐axial brain tumors, in 1993, Sorjonen
et al. [139] investigated a radical cerebral cortical resection
in 10 normal dogs. Their hypothesis was that despite ear-
lier reports, descriptions of surgical landmarks, techniques
for manipulation of intracranial tissue, and postsurgical
results following resection of a large volume of cerebral tis-
sue that is often associated with the removal of large and
deep‐seated neoplasia were largely incomplete. Results of
the study indicated that radical cerebral cortical resection
Figure 1.8 Dr John is considered the pioneer of canine
was feasible and offered a viable alternative to palliative
intracranial surgery. Most of our current surgical approaches to
the brain are based on his original work published in 1968. medical treatment or euthanasia in dogs with large or
Source: Picture courtesy of UGA Library Systems and Dr Marc Kent. deep‐seated brain tumors.
10 Advanced Techniques in Canine and Feline Neurosurgery
The 1990s were also witness to advances in diagnostic 1995, Bagley et al. [145] at Washington State University
techniques and intracranial instrumentation. The increas- reported on the results of longitudinal division of the cor-
ing availability of CT technology promoted the opportunity pus callosum in six normal dogs. These authors proposed
to harvest pathologic tissue from animals with brain dis- this procedure as an adjunct for intractable seizures.
eases for the purpose of distinguishing various types of A bilateral rostrotentorial craniectomy was performed and
pathologic conditions and to help stage brain tumors. In the dorsal sagittal sinus was manipulated in an effort to
1990, Harari et al. [140] at Washington State University remove the overlying cranium and perform the callosot-
evaluated a CT‐guided, free‐hand needle biopsy of brain omy. Elevation in ICP was not noted. The authors con-
tumors in eight dogs. Although the technique was deemed cluded that surgical division of the corpus callosum is a
safe and easy to perform, it yielded diagnostic samples in safe procedure in dogs. In 1996, Pluhar et al. [146] at
only two dogs. In 1993, Thomas et al. [141] at Auburn Washington State University reported on the changes in
University, evaluated an ultrasound‐guided brain biopsy ICP following acute unilateral transverse sinus occlusion
technique of the cingulate gyrus and head of the caudate in six normal dogs. This study was undertaken to validate
nucleus in 10 normal dogs. Postmortem examination indi- or invalidate earlier concerns regarding the reluctance of
cated that the biopsy specimen was obtained from the many veterinary neurosurgeons to avoid violation of the
desired site in 9 dogs (90%) and the tissue specimen was transverse sinus. Such reluctance has resulted in an inabil-
suitable for histologic examination in all 10 dogs (100%). In ity to adequately expose the lateral cerebellomedullary
1999, Koblik et al. [142] at the University of California, pontine area, thus limiting the effectiveness of surgery in
reported the results of a CT‐guided stereotactic brain that region. The authors reported that ICP did not rise after
biopsy technique in 50 dogs using a commercially available unilateral transverse sinus occlusion and proffered the idea
device (Pelorus Mark III Stereotactic System, Ohio Medical that the transverse sinus could safely be occluded to
Instrument Company, Cincinnati, OH). A definitive diag- increase surgical exposure to the caudal fossa of the brain.
nosis was made in 22 dogs by histologic examination of tis- As a clinical follow‐up to their 1996 study, in 1997, Bagley
sue obtained by surgical resection or at necropsy. The et al. [147] safely removed the bone overlying the trans-
definitive diagnosis was in agreement with the stereotactic verse sinus after performing a combined lateral rostroten-
biopsy diagnosis in 20 (91%) dogs. Morbidity associated torial and suboccipital craniectomy. Bone wax was then
with the biopsy procedure was reported to be minimal. The placed in the remaining bony canal of the transverse sinus.
authors concluded that CT‐guided biopsy procedure can These authors successfully performed this procedure in
provide an accurate pathologic diagnosis of brain lesions seven dogs with space‐occupying disease; six located in the
detected by CT or MR neuroimaging. cerebellopontine angle and one in the caudal medulla. In
A natural upshot of improvements in the antemortem 1998, Bagley [148] reported the results of a multicenter
diagnosis of intracranial pathology is the development of study of trigeminal nerve‐sheath tumor in 10 dogs. Three
instrumentation that reduces the morbidity and mortality dogs received surgery and for one of the cases surgery was
associated with brain surgery. In 1991, Shores [143] at described as a lateral rostrotentorial craniectomy that was
Michigan State University, described the technique of extended ventrally to expose the trigeminal nerve and
brain tumor removal using the Cavitron ultrasonic aspira- tumor, which was explored and excised near its origin in
tor (CUSA, Valley Lab, Inc., Stamford, CT) in three dogs. In the brain stem. In one dog with subtotal excision of the
1993, Feder et al. [144] at Oklahoma State University nerve‐sheath tumor, gene therapy was administered. Death
described the use of a neodymium: yttrium‐aluminum‐ or euthanasia resulted in all dogs not receiving surgery;
garnet (Nd:YAG) laser (MediLas2®: Medizintechnik Gmbh, consequently, these authors concluded that “aggressive
Munich, Germany) to aid in the removal of a large, invasive local treatment, with surgery or possibly radiation therapy,
meningioma in a Boxer dog. In both reports, the authors may be necessary to arrest the progression of this tumor.”
commended use of these instruments based on a decrease In 2000, Glass et al. [149] at the University of Pennsylvania
in peritumoral tissue damage as compared to traditional modified surgical techniques first reported by other work-
dissection/suction techniques. ers [134, 135, 150] to approach both the frontal lobe and
Advances in diagnostic techniques and intracranial olfactory bulb in five dogs with seizures. Their technique, a
instrumentation prompted workers to investigate regions modified bilateral transfrontal sinus approach, provided
of the brain previously considered inaccessible. One long‐ clear visualization of olfactory bulb, cribriform plate, and
held belief was that any violation of the dural sinus system the frontal lobe as far caudal as the cruciate sulcus. These
during brain surgery would invariably result in substantial authors reported resolution of seizure activity in all
brain swelling and death of the animal patient [130]. In five dogs.
1 A History of Veterinary Neurosurgery: 1900–2000 11
Reports of intracranial surgery are not as common in reported on a cat with a large pituitary mass noted in
cats as in dogs with the vast majority of reports involving MRI. These authors performed a transsphenoidal approach
brain tumors. Similar to the pattern in dogs, the occur- to the hypophysis as described by Niebauer and
rence of reports involving intracranial pathology in cats Evans [126]. A cryoprobe was applied to the pituitary mass
began to increase in the 1970s and continued to increase and two freeze–thaw cycles were performed. The histo-
into the 1990s. Prior and up to 1960, reports of intracranial pathological diagnosis of the pituitary tumor was an aci-
pathology in cats were largely relegated to textbooks of dophilic adenoma. The cat was euthanized 15 months
veterinary pathology [151, 152]. In 1961, Luginbuhl [153] postoperative for aggressive behavior. Necropsy revealed
at the University of Bern reported that one or more men- no evidence of the pituitary tumor. The aggression was
ingiomas were found in 8 of 155 cat brains examined at attributed to changes in the hippocampus and temporal
necropsy. Although this author addressed the prevalence cortex, a sequela to a postoperative hypoglycemic events.
of meningioma in these cats, the paucity of published The authors concluded that transsphenoidal hypophysec-
reports and the small sample size of this report disallowed tomy was feasible in the cat and cryosurgery was benefi-
him from any conclusions regarding incidence, signifi- cial. In 1999, Simpson, et al. [159] at the University of
cance, and types of meningiomas which occur in cats. Sydney, reported the surgical removal of an ependymoma
However, in the ensuing years, this information regarding from the third ventricle of a cat. These authors performed
meningioma in cats became apparent. In 1979, Nafe [154] a rostrotentorial craniectomy to expose the brain. A longi-
at the AMCNY, reported on 36 cases of meningiomas in tudinal incision in the ectomarginal gyrus allowed expo-
cats; surgery was not performed on any cat. In 1984, sure of the lateral ventricle through which the third
Lawson et al. [155] at the AMCNY reported on the diagno- ventricle was accessed. A friable grey mass was removed
sis and surgical treatment of cerebral meningioma in 10 from the lumen of the third ventricle. A histopathological
cats. Interestingly, the diagnosis was confirmed by hyper- diagnosis of ependymoma was rendered. This cat made an
ostotic bone noted in skull radiographs in nine cats. A ros- unremarkable recovery. The authors concluded that
trotentorial craniectomy of varying extent was performed “ependymoma should be considered together with menin-
in all cats. The tumors were debulked or removed en bloc giomas as intracranial tumours amendable to surgical
when possible. In three cats with falx meningiomas, the intervention, even when situated in the relatively inacces-
craniectomy was made to cross the midline without dis- sible third ventricle.”
ruption of the dorsal sagittal sinus. In the two cats with
tumors involving the sphenoid wing, brain retraction was
performed to access the floor of the calvarium. One cat Epilogue
died of brain herniation and nine cats were released to
home by postoperative day five. An uptick in case reports The twentieth century stands witness to a multitude of
of brain tumors in cats, coincident with the advent of CT remarkable advances in both the art and science of vet-
and MRI, occurred in the 1990s. In 1991, Niebauer erinary neurosurgery. From reports of early workers
et al. [137] at the University of Pennsylvania, in using largely logic and intuition to guide their decisions
1993 Gallagher et al. [156] at Tufts University, and in 1994 for surgery, to more contemporary workers with an arma-
Gordon et al. [157] at the AMCNY all reported a series of mentarium of advanced imaging and diagnostic modali-
intracranial meningiomas in cats treated with surgery. ties to predicate surgical goals, one unifying concept
Surgical techniques similar to those employed in dogs emerges: to provide the best care for the animal patient
were used and varied based on lesion localization. In gen- with neurologic disease. One has to believe that the con-
eral, meningiomas in cats are more likely to be firm com- cern for the wellbeing of the animal patient and the bold-
pared to the friable meningiomas in dogs allowing a ness necessary to establish newer neurosurgical
greater opportunity for en‐bloc tumor removal in cats. techniques is not unique to earlier neurosurgeons but
Compared to dogs, cats are more likely to have multiple instead is common among individuals driven by compas-
sites of meningioma in the brain and can often experience sion to be of help. These human characteristics, well
life threating postoperative anemia. established among veterinarians, together with the con-
Whereas meningioma is the most common brain tumor tinuing advancement in diagnostic techniques and the
of cats, surgical management of tumors affecting the availability of newer surgical instrumentation, will serve
hypophysis and ependyma have been reported. In 1993, to provide the opportunity for ever improving animal
Abrams‐Ogg et al. [158] at the University of Guelph care in the twenty‐first century.
12 Advanced Techniques in Canine and Feline Neurosurgery
References
1. Guthrie, E. (1939), History of veterinary medicine. In: 18. Whiteleather, J.E. and DeSaussuer, R.I. (1956). New
Iowa State University Veterinarian, vol. 2, 6–10. Ames, IA: contrast medium (Hypaque) for cerebral angiography.
Iowa State Press. Radiology 67: 537–541.
2. RCVS (2010). Global veterinary medicine timeline. 19. Dorn, A.S. (1968). Cerebral angiography in the dog.
https://knowledge.rcvs.org.uk/heritage-and-history/ Thesis (MS). Auburn University, Auburn, AL.
history-of-the-veterinary-profession/global-veterinary- 20. Hoerlein, B.F. and Petty, M.F. (1961). Contrast
medicine-timeline/ (accessed 21 April 2022). encephalography and ventriculography in the dog‐
3. Greenblatt, S.H., Dagi, T.F., and Epstein, M.H. (ed.) preliminary studies. Am. J. Vet. Res. 22: 1041–1046.
(1997). A History of Neurosurgery, 625. Park Ridge, IL: 21. Cobb, L.M. (1960). Pneumoencephalography in the dog.
The American Association of Neurological Surgeons. Can. Vet. J. 1: 444–449.
4. Tufts University (2013). A brief history of radiologic time. 22. Hounsfield, G.N. (1973). Computerized transverse
www.tuftsyourdog.com/doghealthandmedicine/a-brief- axial scanning (tomography). 1. Description of system.
history-of-radiologic-time/ (accessed 21 April 2022). Br. J. Radiol. 46: 1016–1022.
5. Carlson, W.D. (1967). Veterinary Radiology, 2e, 275. 23. Marineck, B. and Young, S.W. (1980). Computed‐
Philadelphia, PA: Lea & Febiger. tomography of spontaneous canine neoplasms. Vet.
6. Olsson, S.E. (1951). On disk protrusion in the dog Radiol. 21: 181–184.
(enchondiosis intervertebralis). Acta Orthop. Scand. 24. LeCouter, R.A., Fike, J.R., Cann, C.E., and Pedroia,
Suppl. 8: 1–49. V.G. (1981). Computed‐tomography of brain‐tumors in
7. Hoerlein, B.F. (1953). Various contrast media in canine the caudal fossa of the dog. Vet. Radiol. 22: 244–251.
myelography. J. Am. Vet. Med. Assoc. 123: 311–315. 25. Hawn, E.L. (1950). Spin echoes. Phys. Rev. 80: 580–594.
8. Bartles, J.E., Hoerlein, B.F., and Boring, B.S. (1978). 26. Lautebar, P.C. (1973). Image formation by induced local
Neuroradiology. In: Canine Neurology, 3e (ed. interactions: examples of employing nuclear magnetic
B.F. Hoerlein), 103–133. Philadelphia, PA: WB Saunders. resonance. Nature 242: 190–191.
9. Wilson, J.W., Bahr, R.J., Leipold, H.W., and Guffy, 27. Goldstein, E.J., Burnett, K.R., Wolf, G.L. et al. (1985).
M.M. (1976). Acute leptomeningeal reaction to the Contrast enhanced spontaneous animal CNS tumors with
subarachnoid injection of ethyl iodophenyl undecylate in gadolinium DTPA: a correlation of MRI with x‐ray
dogs. J. Am. Vet. Med. Assoc. 169: 415–419. CT. Physiol. Chem. Phys. Med. NMR 17: 113–122.
10. Greene, J.E. (1951). Surgical intervention for paraplegia 28. Kraft, S.L., Gavin, P.R., Wendling, L.R., and Reddy,
due to herniation of the nucleus pulposus. North Am. Vet. V.K. (1989). Canine brain anatomy on magnetic
32: 411–412. resonance images. Vet. Radiol. Ultrasound 30: 147–158.
11. Klide, A.M., Steinberg, S.A., and Pond, M.J. (1967). 29. Kärkkäinen, M., Punto, L.U., and Tulamo, R.M. (1993).
Epiduralograms in dogs: the use and advantages of the Magnetic resonance imaging of canine degenerative
diagnostic procedure. J. Amer. Vet. Radiol. 8: 39–42. lumbar spine disease. Vet. Radiol. Ultrasound 34: 399–404.
12. Garrick, J.G. and Sullivan, C.R. (1961). A technic of 30. Vaughan, L.C. (1968). Studies on intervertebral disk
performing diskography in dogs. Proc. Mayo. Clin. 39: protrusion in the dog. I. Etiology and pathogenesis.
270–275. II. Diagnosis of the disease. III. Pathologic features.
13. Conrad, C.R. (1975). Radiographic examination of the IV. Treatment. Brit. Vet. 114: 105–125.
central nervous system. In: Textbook of Veterinary Internal 31. Leonard, E.P. (1971). Orthopedic Surgery of the Dog
Medicine: Diseases of the Dog and Cat (ed. S.J. Ettinger), and Cat, 2e, 115–117. Philadelphia, PA: WB Saunders.
351–355. Philadelphia, PA: WB Saunders. 32. Ross, G.E. (1969). Surgical treatment of intervertebral
14. Holtermann, H. (1973). Metrizamide. Acta Radiol. Suppl. disk disease. Proc. Am. Anim. Hosp. Assoc. 36th Annu.
335: 1–4. Meet. 409–411.
15. Douglas, S.W. and Williamson, H.D. (1963). Principals of 33. Northway, R.B. (1965). A ventrolateral approach to
Veterinary Radiology, 177–184. Baltimore, MD. lumbar intervertebral disk fenestration. Vet. Med. Small
16. James, C.W. and Hoerlein, B.F. (1960). Cerebral Anim. Clin. 60: 884–889.
angiography in the dog. Vet. Med. 55: 45–49. 34. Hoerlein, B.F. (1968). Various surgical methods for
17. James, C.W. (1963). Radiographic anatomy of the cerebral repair of intervertebral disk protrusions. Anim. Hosp.
arterial system of the dog. Master thesis. Auburn 4: 12–18.
University, Auburn, AL.
1 A History of Veterinary Neurosurgery: 1900–2000 13
35. Flo, G.L. and Brinker, W.O. (1975). Lateral fenestration of 51. Swaim, S.F. (1971). Vertebral body plating for spinal
thoracolumbar disks. J. Am. Anim. Hosp. Assoc. 11: immobilization. J. Am. Vet. Med. Assoc. 158: 1683–1695.
619–621. 52. Gage, E.D. (1969). A new method of spinal fixation in the
36. Yturraspe, D.J. and Lumb, W.V. (1973). A dorsolateral dog. Vet. Med. Small Anim. Clin. 64: 295–303.
muscle‐separating approach for thoracolumbar 53. Gage, E.D. (1969). Surgical Repair of Spinal Fractures in
intervertebral disk fenestration in the dog. J. Am. Vet. Toy Breed Dogs, 29–36. Southwestern Veterinarian; Fall.
Med. Assoc. 162: 1037–1042. 54. Rouse, G.P. and Miller, J.I. (1975). The use of
37. Seeman, C.W. (1968). Lateral approach for thoracolumbar methylmethacrylate for spinal stabilization. J. Am. Anim.
disk fenestration. Mod. Vet. Pract. 49: 73–77. Hosp. Assoc. 11: 418–423.
38. Braund, K.G., Taylor, T.K., Ghosh, P., and Sherwood, 55. Blass, C.E. and Seim, H.B. (1984). Spinal fixation in dogs
A.A. (1976). Lateral spinal decompression in the dog. using Steinmann pins and methylmethacrylate. Vet. Surg.
J. Sm. Anim. Pract. 17: 583–592. 13: 203–210.
39. Brook, G.B. (1936). The Spine of The Dog, 95–96. 56. Wong, W.T. and Emms, S.G. (1992). Use of
Baltimore, MD: W. Wood Co. methylmethacrylate in stabilization of spinal fractures
40. Redding, R.W. (1951). Laminectomy in the dog. Am. and luxations. J. Sm. Anim. Pract. 33: 415–422.
J. Vet. Res. 12: 123–128. 57. Brasmer, T.H. and Lumb, W.V. (1972). Lumbar vertebral
41. Hoerlein, B.F. (1956). Further evaluation of the treatment prosthesis in the dog. Am. J. Vet. Res. 33: 493–499.
of disk protrusion in the dog. J. Am. Vet. Med. Assoc. 129: 58. Yturraspe, D.J., Lumb, W.V., Young, S., and Gorman,
495–502. H.A. (1975). Neurological and pathological effects of
42. Swaim, S.F. (1976). Bilateral hemilaminectomy: a second lumbar spondylectomy and spinal column
technique for extensive spinal decompression. Auburn shorting in the dog. J. Neurosurg. 42: 47–50.
Vet. 62: 32–38. 59. Knecht, C.D. (1972). Results of surgical treatment for
43. Swaim, S.F. (1977). Clinical and histologic evaluation of thoracolumbar disc protrusion. J. Sm. Anim. Prac. 13 (8):
bilateral hemilaminectomy and deep dorsal laminectomy 449–453.
for extensive spinal cord decompression in the dog. J. Am. 60. Northway, R.B. (1966). Fusion of the lumbar vertebrae in
Vet. Med. Assoc. 170: 407–413. the dog. Vet. Med. Small Anim. Clin. 61: 1190–1196.
44. Funkquist, B. (1962). Thoraco‐lumbar disk protrusion 61. Slocum, B. and Rudy, R.L. (1975). Fractures of the
with severe cord compression in the dog. I. Clinical and seventh lumbar vertebra in the dog. J. Am. Anim. Hosp.
patho‐anatomic observations with special reference to Assoc. 11: 167–172.
the rate of development of symptoms of motor loss. 62. Dulisch, M.L. and Nichols, J.B. (1981). A surgical
II. Clinical observations with special reference to technique for management of lower lumbar fractures:
prognosis in conservative treatment. III. Treatment by case report. Vet. Surg. 10: 90–91.
decompressive laminectomy. Acta Vet. Scand. 3: 256–274. 63. Ullman, S.L. and Boudrieau, R.J. (1993). Internal skeletal
45. Trotter, E.J. and deLahunta, A. (1975). Modified deep fixation using a Kirschner apparatus for stabilization of
dorsal laminectomy in the dog. Cornell Vet. 65: 402–427. fracture/luxation of lumbosacral joint in six dogs. A
46. Prata, R.G. (1981). Neurosurgical treatment of modification of the transilial pin technique. Vet. Surg.
thoracolumbar disks: the rationale and value of 22: 11–17.
laminectomy with concurrent disk removal. J. Am. Anim. 64. McAnulty, J.F., Lenehan, T.M., and Maletz, L.M. (1986).
Hosp. Assoc. 17: 17–26. Modified segmental spinal instrumentation in repair of
47. Hoerlein, B.F. (1978). Intervertebral disks. In: Canine spinal fractures and luxations in dogs. Vet. Surg. 15:
Neurology, 3e (ed. B.F. Hoerlein), 549–550. Philadelphia, 143–149.
PA: WB Saunders. 65. Shores, A., Nichols, C., Koelling, H.A., and Fox,
48. Brisson, B.A. (2017). Pediculectomy/mini‐ W.R. (1988). Combined Kirschner‐Ehmer apparatus and
hemilaminectomy. In: Current Techniques in Canine and dorsal spinal plate fixation of caudal lumbar fractures in
Feline Neurosurgery (ed. A. Shores and B.A. Brisson), 183. dogs: biomechanical properties. Am. J. Vet. Res. 49:
Hoboken, NJ: Wiley. 1979–1982.
49. Hoerlein, B.F. (1953). Successful correction of a vertebral 66. Oliver, J.E., Selcer, R.R., and Simpson, S. (1978). Cauda
fracture in a dog. Auburn Vet. 10: 15–17. equina compression from lumbosacral malarticulation
50. Hoerlein, B.F. (1956). Traumatic lesions of the canine and malformation in the dog. J. Am. Vet. Med. Assoc. 173:
spine. Am. J. Vet. Res. 17: 685–689. 207–214.
14 Advanced Techniques in Canine and Feline Neurosurgery
67. Tarvin, G. and Prata, R.G. (1980). Lumbosacral stenosis 84. Geary, J.C., Oliver, J.E., and Hoerlein, B.F. (1967).
in dogs. J. Am. Vet. Med. Assoc. 177: 154–159. Atlanto axial subluxation in the canine. J. Small Anim.
68. Slocum, B. and Devine, T. (1986). L7‐S1 fixation‐fusion Pract. 8: 577–582.
for treatment of cauda equina compression in the dog. 85. Gage, E.D. and Smallwood, J.E. (1970). Surgical repair
J. Am. Vet. Med. Assoc. 188: 31–35. of atlanto‐axial subluxation in a dog. Vet. Med. Small
69. Bietto, W.V. and Thatcher, C. (1987). A modified lateral Anim. Clin. 65: 583–592.
decompression technique for treatment of canine 86. Oliver, J.E. and Lewis, R.E. (1973). Lesions of the atlas
intervertebral disk disease. J. Am. Anim. Hosp. Assoc. 23: and axis in dogs. J. Am. Anim. Hosp. Assoc. 9: 304–313.
409–413. 87. Chambers, J.N., Betts, C.W., and Oliver, J.E. (1977). The
70. McCartney, W. (1977). Partial pediculectomy for use of nonmetallic suture material for stabilization of
treatment of thoracolumbar disk disease. Vet. Comp. atlantoaxial subluxation. J. Am. Anim. Hosp. Assoc. 13:
Orthop. Traumatol. 10: 117–121. 602–605.
71. Hoerlein, B.F. (1952). The treatment of intervertebral 88. Renegar, W.R. and Stoll, S.G. (1979). The use of
disk protrusion in the dog. Proc. Am. Vet. Med. Assoc. 89: methylmethacrylate bone cement in the repair of
206–208. atlantoaxial subluxation stabilization failures‐case
72. Funkquist, B. (1962). Decompressive laminectomy for report and discussion. J. Am. Anim. Hosp. Assoc. 15:
cervical disk protrusion in the dog. Acta Vet. Scand. 313–318.
3: 88–101. 89. LeCouteur, R.A., McKeown, D., Johnson, J., and Eger,
73. Hoerlein, B.F. (1962). Cervical spinal surgery – ventral C.E. (1980). Stabilization of atlantoaxial subluxation in
and dorsal approach. Proc. Am. Vet. Med. Assoc. the dog, using the nuchal ligament. J. Am. Vet. Med.
103–104. Assoc. 177: 1011–1017.
74. Popovic, N.A., VanderArk, G., and Kempe, L. (1971). 90. Kishigami, M. (1984). Application of an atlantoaxial
Ventral approach for surgical treatment of cervical disk retractor for atlantoaxial subluxation in the cat and dog.
disease in the dog. Am. J. Vet. Rsch. 32: 1155–1161. J. Am. Anim. Hosp. Assoc. 20: 413–419.
75. Cloward, R.B. (1958). The anterior approach for removal 91. Jeffery, N.D. (1996). Dorsal cross pinning of the
of ruptured cervical disks. J. Neurosurg. 15: 602–617. atlantoaxial joint: new surgical technique for
76. Swaim, S.F. (1973). Ventral decompression of the atlantoaxial subluxation. J. Sm. Anim. Pract. 37: 26–29.
cervical spinal cord in the dog. J. Am. Vet. Med. Assoc. 92. Sorjonen, D.C. and Shires, P.K. (1981). Atlantoaxial
162: 276–277. instability: a ventral surgical technique for
77. Prata, R.G. and Stoll, S.G. (1973). Ventral decompression decompression, fixation, and fusion. Vet. Surg. 10: 22–29.
and fusion for the treatment of cervical disk disease in 93. Denny, H.R., Gibbs, C., and Waterman, A. (1988).
the dog. J. Am. Anim. Hosp. Assoc. 9: 462–472. Atlanto‐axial subluxation in the dog: a review of thirty
78. Gilpin, G.N. (1976). Evaluation of three techniques of cases and an evaluation of treatment by lag screw
ventral decompression of the cervical spinal cord in the fixation. J. Small Anim. Pract. 29: 37–47.
dog. J. Am. Vet. Med. Assoc. 168: 325–328. 94. Blass, C.E., Waldron, D.R., and vanEe, R.T. (1988).
79. Goring, R.L., Beale, B.S., and Faulkner, R.F. (1991). The Cervical stabilization in three dogs using Steinmann
inverted cone decompression technique: a surgical pins and methylmethacrylate. J. Am. Anim. Hosp. Assoc.
treatment for cervical vertebral instability “Wobbler 24: 61–68.
Syndrome” in Doberman Pinchers. J. Am. Anim. Hosp. 95. Stead, A.C., Anderson, A., and Coughlan, A. (1993).
Assoc. 27: 403–409. Bone plating to stabilize atlantoaxial subluxation in four
80. Pettit, G.D. and Whittaker, R.P. (1963). Hemilaminectomy dogs. J. Sm. Anim. Pract. 34: 462–465.
for cervical disk protrusion in a dog. J. Am. Vet. Med. 96. deLahunta, A. (1971). Cervical cord contusion from
Assoc. 143: 379–383. spondylolisthesis (A wobbler syndrome in dogs). In:
81. Parker, A.J. (1973). Surgical approach to the cervico‐ Current Veterinary Therapy, 4e (ed. R.W. Kirk), 917–930.
thoracic junction. J. Am. Anim. Hosp. Assoc. 9: Philadelphia, PA: WB Saunders.
374–377. 97. Gage, E.D. and Hall, C.L. (1972). Surgical repair of
82. Felts, J.F. and Prata, R.G. (1983). Cervical disk disease in caudal cervical subluxation in a dog. J. Am. Vet. Med.
the dog: intraforaminal and lateral extrusions. J. Am. Assoc. 160: 424–426.
Anim. Hosp. Assoc. 19: 755–760. 98. Dueland, R., Furneaux, R.W., and Kaye, M.M. (1973).
83. Lipsitz, D. and Bailey, C.S. (1992). Lateral approach for Spinal fusion and dorsal laminectomy for midcervical
cervical spinal cord decompression. Prog. Vet. Neurol. spondylolisthesis in a dog. J. Am. Vet. Med. Assoc. 162:
3: 39–44. 366–369.
1 A History of Veterinary Neurosurgery: 1900–2000 15
99. Gage, E.D. and Hoerlein, B.F. (1973). Surgical repair of 114. Hawthorne, J.C., Blevins, W.E., Wallace, L.J. et al. (1999).
cervical subluxation and spondylolisthesis in the dog. Cervical vertebral fractures in 56 dogs: a retrospective
J. Am. Anim. Hosp. Assoc. 9: 385–390. study. J. Am. Anim. Hosp. Assoc. 35: 135–146.
100. Swaim, S.F. (1975). Evaluation of four techniques of 115. Brinker, W.O. (1957). Canine Surgery, 4e (ed. K. Mayer,
cervical spinal fixation in dogs. J. Am. Vet. Med. Assoc. J.V. Lacroix and H.P. Hoskins), 666. Evanston, IL:
166: 1080–1086. American Veterinary Publications.
101. Trotter, E.J., deLahunta, A., Geary, J.C., and Brasmer, 116. Leonard, E.P. (1960). Fractures of the skull, spine and
T.H. (1976). Caudal cervical vertebral malarticulation‐ pelvis. In: Orthopedic Surgery of the Dog and Cat (ed.
malformation in Great Danes and Doberman Pinchers. E.P. Leonard), 247. Philadelphia, PA: WB Saunders.
J. Am. Vet. Med. Assoc. 168: 917–930. 117. Andersson, B. (1956). A case of nervous canine
102. Lincoln, J.D. and Pettit, G.D. (1985). Evaluation of distemper treated with prefrontal lobotomy. Nord. Vet.
fenestration for treatment of degenerative disk disease Med. 8: 179–182.
in the caudal cervical region of large dogs. Vet. Surg. 14: 118. Redding, R.W. (1972). Prefrontal lobotomy of the dog.
240–246. Scientific presentations. J. Am. Anim. Hosp. Assoc.
103. Ellison, G.W., Seim, H.B., and Clemmons, R.M. (1988). 374–378.
Distracted cervical spinal fusion for management of 119. Allen, B.D., Cummings, J.F., and deLahunta, A. (1974).
caudal cervical spondylomyelopathy in large‐breed The effects of prefrontal lobotomy on aggressive
dogs. J. Am. Vet. Med. Assoc. 193: 447–453. behavior in dog. Cornell Vet. 64: 201–215.
104. Bruecker, K.A., Seim, H.B., and Blass, C.E. (1989). 120. Hart, B.L. (1982). Neurosurgery of behavioral problems.
Caudal cervical spondylomyelopathy: decompression by A curiosity or the new wave. Vet. Clin. North Am. Small
linear traction and stabilization with Steinmann pins Anim. Pract. 126: 707–714.
and polymethyl methacrylate. J. Am. Anim. Hosp. Assoc. 121. Few, A. (1966). The diagnosis and surgical treatment of
25: 677–683. canine hydrocephalus. J. Am. Vet. Med. Assoc. 149:
105. McKee, W.M., Lavelle, R.B., Richardson, J.L., and 286–292.
Mason, T.A. (1990). Vertebral distraction‐fusion for 122. Gage, E.D. and Hoerlein, B.F. (1968). Surgical treatment
cervical spondylopathy using a screw and double of canine hydrocephalus by ventriculoatrial shunting.
washer technique. J. Small Anim. Pract. 31: 22–27. J. Am. Vet. Med. Assoc. 153: 1418–1431.
106. Lyman, R. (1991). Continuous dorsal laminectomy 123. Markowitz, J. and Archibald, J. (1956). Transbuccal
is the procedure of choice. Prog. Vet. Neurol. 2: hypophysectomy in the dog. Can. J. Biochem. Physiol. 34:
143–146. 422–428.
107. Hettlich, B. (2017). Vertebral fracture and luxation 124. Alvarez‐Buylla, R., Segura, E.T., and Alvarez Buylla,
repair. In: Current Techniques in Canine and Feline E.R. (1961). Participation of the hypophysis in the
Neurosurgery (ed. A. Shores and B.A. Brisson), 211. conditioned reflex which reproduces the hypoglycemic
Hoboken, NJ: Wiley. effect of insulin. Acta Physiol. Lat. Am. 11: 113–119.
108. Gage, E.D. (1968). Surgical repair of a fractured 125. Henry, R.W., Hulse, D.A., Archbald, L.F., and Barta, M.
cervical spine in the dog. J. Am. Vet. Med. Assoc. 153: (1982). Transoral hypophysectomy with mandibular
1407–1411. symphysiotomy in the dog. Am. J. Vet. Res. 43:
109. Hoerlein, B.F. (1958). Traumatic lesions of the canine 1825–1829.
spine. Mod. Vet. Pract. 39: 31–37. 126. Niebauer, G.W. and Evans, S.M. (1988). Transsphenoidal
110. Gendreau, C.L. and Cawley, A.J. (1969). Repair of hypophysectomy in the dog. A new technique. Vet. Surg.
fractures of the axis. Can. Vet. J. 10: 297–301. 17: 296–303.
111. Rouse, G.P. (1979). Cervical spine stabilization with 127. Meij, B.P. (1998). Transsphenoidal hypophysectomy for
methylmethacrylate. Vet. Surg. 8: 1–6. treatment of pituitary‐dependent hyperadrenocorticism
112. Basinger, R.R., Bjorling, D.E., and Chambers, in dogs. Vet. Quart. Suppl. 20: S98–S100.
J.N. (1986). Cervical spinal luxation in two dogs with 128. Oliver, J.E. (1965). Surgical relief of epileptiform
entrapment of the cranial articular process of C6 over seizures in the dog. Vet. Med. Small Anim. Clin. 60:
the caudal articular process of C5. J. Am. Vet. Med. 367–368.
Assoc. 188: 865–867. 129. Hoerlein, B.F., Few, A.B., and Petty, M.F. (1963). Brain
113. Boudrieau, R.J. (1997). Distraction‐stabilization using surgery in the dog‐preliminary studies. J. Am. Vet. Med.
the Scoville‐Haverfield self‐retaining laminectomy Assoc. 143: 21–29.
retractors for repair of 2nd cervical vertebral fractures in 130. Oliver, J.E. (1968). Surgical approaches to the canine
3 dogs. Vet. Comp. Orthop. Traumatol. 10: 71–76. brain. Am. J. Vet. Res. 29: 353–378.
16 Advanced Techniques in Canine and Feline Neurosurgery
131. Parker, A.J. (1972). Transfrontal craniotomy in the dog. 146. Pluhar, G.E., Bagley, R.S., Keegan, R.D. et al. (1996). The
Vet. Rec. 90: 622–624. effect of acute, unilateral transverse venous sinus
132. Swaim, S.F. (1973). Use of pneumatic surgical occlusion on intracranial pressure in normal dogs. Vet.
instruments in neurosurgery. Vet. Med. Small Anim. Surg. 25: 480–486.
Clin. 68: 1404–1412. 147. Bagley, R.S., Harrington, M.L., Pluhar, G.E. et al.
133. de Wet, P.D. (1977). Some anatomical and functional (1997). Acute, unilateral transverse sinus occlusion
considerations with regard to general and experimental during craniectomy in seven dogs with space‐occupying
canine brain surgery. Zbl. Vet. Med. C Anat. Histol. intracranial disease. Vet. Surg. 26: 195–201.
Embryol. 6: 87–88. 148. Bagley, R.S., Wheeler, S.J., Klopp, L. et al. (1998).
134. de Wet, P.D., Alt, I.I., and Peters, D.N. (1982). Surgical Clinical features of trigeminal nerve‐sheath tumor in 10
approach to the rostral cranial fossa by radical dogs. J. Am. Anim. Hosp. Assoc. 34: 19–25.
transfrontal craniotomy in the dog. J. South African Vet. 149. Glass, E.N., Kapatkin, A., Vite, C., and Steinberg,
Assoc. 53: 40–51. S.A. (2000). A modified bilateral transfrontal sinus
135. Parker, A.J. and Cunningham, J.G. (1971). Successful approach to the canine frontal lobe and olfactory bulb:
surgical removal of an epileptogenic focus in a dog. surgical technique and five cases. J. Am. Anim. Hosp.
J. Small Anim. Pract. 12: 513–521. Assoc. 36: 43–50.
136. Bagedda, G. (1972). The EEG as an aid to the 150. Kostolich, M. and Dulisch, M. (1987). A surgical
topographical diagnosis of a cerebral lesion in a puppy: approach to the canine olfactory bulb for meningioma
neurosurgical treatment and the post‐operative removal. Vet. Surg. 16: 273–277.
EEG‐clinical course. J. Small Anim. Pract. 13: 185–192. 151. Smith, H.A. and Jones, T.C. (1957). Veterinary Pathology,
137. Niebauer, G.W., Dayrell‐Hart, B.L., and Speciale, J. 208. Philadelphia, PA: Lea & Febiger.
(1991). Evaluation of craniotomy in dogs and cats. 152. McGrath, J.T. (1960). Neurologic Examination of the Dog,
J. Am. Vet. Med. Assoc. 198: 89–95. 152. Philadelphia, PA: Lea & Febiger.
138. Jeffery, N. and Brearley, M.J. (1993). Brain tumors in the 153. Luginbuhl, H. (1961). Studies of meningiomas in cats.
dog: 10 cases and review of recent literature. J. Small Am. J. Vet. Res. 22: 1030–1040.
Anim. Pract. 34: 367–372. 154. Nafe, L. (1979). Meningiomas in cats: a retrospective
139. Sorjonen, D.C., Thomas, W.B., Myers, L.J., and Cox, clinical study of 36 cases. J. Am. Vet. Med. Assoc. 174:
N.R. (1993). Radical cerebral cortical resection in dogs. 1224–1227.
Prog. Vet. Neurol. 2: 225–236. 155. Lawson, D.C., Burk, R.L., and Prata, R.G. (1984).
140. Harari, J., Moore, M.P., Leathers, C.W. et al. (1992). Cerebral meningiomas in the cat: diagnosis and surgical
Computed tomographic‐guided free‐hand needle biopsy treatment of ten cases. J. Am. Anim. Hosp. Assoc. 20:
of brain tumors in dogs. Prog. Vet. Neurol. 4: 41–44. 333–342.
141. Thomas, W.B., Sorjonen, D.C., Hudson, J.A., and Cox, 156. Gallagher, J.G., Berg, J., Knowles, K. et al. (1993).
N.R. (1993). Ultrasound‐guided brain biopsy in dogs. Prognosis after surgical excision of cerebral
Am. J. Vet. Res. 54: 1942–1947. meningiomas in cats: 17 cases (1986–1992). J. Am. Vet.
142. Koblik, P.D., LeCouteur, R.A., Higgins, R.J. et al. (1999). Med. Assoc. 203: 1437–1440.
CT‐guided brain biopsy using a modified Pelorus Mark 157. Gordon, L.E., Thacher, C., Matthiesen, D.T., and
III stereotactic system: experience with 50 dogs. Vet. Joseph, R.J. (1994). Results of craniotomy for treatment
Radiol. Ultrasound 40: 434–440. of cerebral meningiomas in 42 cats. Vet. Surg.
143. Shores, A. (1991). Use of the ultrasound aspirator in 23: 94–100.
intracranial surgery: technique and case reports. Prog. 158. Abrams‐Ogg, A.C.G., Holmberg, D.L., Stewart, W.A.,
Vet. Neurol. 2: 89–94. and Claffey, F.P. (1993). Acromegaly in a cat:
144. Feder, B.M., Fry, T.R., Kostolich, M. et al. (1993). diagnosis by magnetic resonance imaging and
Nd:YAG laser cytoreduction of an invasive intracranial treatment by cryohypophysectomy. Can. Vet. J. 34:
meningioma in a dog. Prog. Vet. Neurol. 4: 3–9. 682–685.
145. Bagley, R.S., Baszler, T.V., Harrington, M.L. et al. (1995). 159. Simpson, D.J., Hunt, G.B., Tisdall, P.L. et al. (1999).
Clinical effects of longitudinal division of the corpus Surgical removal of an ependymoma from the third
callosum in normal dogs. Vet. Surg. 24: 122–127. ventricle of a cat. Aust. Vet. J. 77: 645–648.
17
“Necessity is the mother of invention” is an idiom that per- in post print processing. The thermoplastics most often
tains to veterinary medicine in ways unthinkable to other used are acrylonitrile butadiene styrene (ABS) and polylac-
fields. The anatomic variation of domestic animals and tic acid (PLA). FDM prints have a characteristic ridged
relative financial limitations of treating them have embold- appearance from the distinct layered plastic which can be
ened veterinarians to be entrepreneurial and creative in minimized but not removed through sanding and acetone
their approach to treating animals. Makeshift instrumenta- polishing. ABS is the plastic used for mass production
tion to suit the needs of the individual practitioner is com- injection molding industry. PLA is a biodegradable ther-
monplace. 3D printing (3DP) lends itself to this spirit of moplastic derived from renewable resources such as corn
ingenuity as any structure can be created with exquisite starch or sugarcane and is thought of as “softer.” Both plas-
detail and limitless customization to suit an individual ani- tics are of similar tensile strength, elasticity, and cost. ABS
mal’s needs and be available to general consumers, repre- is more heat resistant than PLA but is considered more dif-
senting >80% of the current market share. These printers ficult to print with and is more failure prone. Neither mate-
are now cost affordable to the hobbyist, often less than a rial can be steam autoclaved. More recent material options
few hundred dollars. The technology (also known as fused include filled nylon which shares the ideal properties of
filament fabrication) uses a filament (often a thermoplas- both. PEEK (polyetheretherketone) is a plastic with desir-
tic) that can be melted by a heated extruder creating able biomechanical properties often used in medical
successive layers that melt and then harden, binding devices. The material can be manipulated as a filament in
them in 3DP. FDM printers but requires specialized extruders and both
3DP, also known as additive modeling (AM), is the printers and the filaments are expensive.
practice of joining or fusing materials by an automated STL printing was the original form of 3DP. Through pho-
process in a 3D envelope. The original iterations of 3DP topolymerization, liquid resins are hardened layer by layer
were created in the 1980s and slowly have become more through a transparent silicone basin by an ultraviolet laser
widely available in the marketplace. The practice was ini- onto a rising build platform. The technology has become
tially thought of as a prototyping mechanism but in more readily available with initial setups in the $4000
recent years has evolved into large‐scale production tech- range1. STL prints require more extensive post‐print‐
niques. The two commonplace 3DP technologies cur- processing than FDM, including removal of supports,
rently available are Fused Deposition Modeling (FDM) clearing of residual resin by alcohol baths, and resin curing
and Stereolithography (STL). in UV chambers. STL prints have a higher part accuracy
FDM is the most commonly available form of 3DP prede- than FDM (1 mm vs. 25 μm) with more defined and resolved
signed orientation. In this regard the extruder moves in an details and no ridges. STL print equipment is sensitive as it
x and y plane and then the z plane is created as the extruder relies on lasers and mirrors for accuracy which can lead to
moves away from the print bed after each layer. Support print failure.
structures (“rafts and bridges”) can be created to permit for
more complicated overhanging structures and are removed 1 Formlabs, Inc.; Somerville, MA, USA
Advanced Techniques in Canine and Feline Neurosurgery, First Edition. Edited by Andy Shores and Brigitte A. Brisson.
© 2023 John Wiley & Sons, Inc. Published 2023 by John Wiley & Sons, Inc.
Companion site: www.wiley.com/go/shores/advanced
Another random document with
no related content on Scribd:
dangerous situations. The tide rose very rapidly, and all the
temporary embarrassments of our situation vanished with our
footprints in the sand. The mounting sun soon burned up the fog,
which in dispersing produced its usual singular and fantastic effects
upon the rugged and precipitous shores that lay on each side; and
retaining the services of our old friend as pilot, we ran through the
river, which is about four miles long, and connected with the harbor
of Gloucester by a short canal, through which we passed, and spent
another pleasant day in that town previous to starting for Boston;
which place we had left just three weeks before. We arrived there
the next day, meeting with nothing worthy of particular notice in the
course of it.
CHAPTER V.
Departure from Malta.—Arrival at Sicily.—Syracuse Ruins.—Ear of
Dionysius.
Our vessel landed her cargo at Malta, and then took in ballast
and sailed for Palermo, in Sicily, to load with fruit. I preferred to cross
immediately over to Syracuse, and take Mount Ætna in my way,
being very desirous not to lose a sight of this celebrated volcano. I
found a Sicilian vessel about to sail, and took passage in her. She
was a polacre, having the masts of single sticks from top to bottom,
instead of three or four pieces joined together, like the masts of
English and American vessels. I could not help laughing at the
oddities of the crew: there were fifteen of them, although the vessel
was not above seventy tons burthen. They were the queerest ship’s
company I ever saw; all captains and mates, and no common
sailors. Whatever was to be done was everybody’s business: there
was no discipline, no order, no concert; all was hurly-burly, and
scampering here and there, and tumbling head over heels.
Which was the commander, nobody could tell, for every one was
giving orders. The slightest manœuvre caused a clatter and bawling
that made me think the masts were going overboard. If there was a
rope as big as a tom-cod-line to be pulled, the whole crew would
string themselves along it, yo! heave ho! tug it an inch and a half,
puff and blow, thump and clamor, as if it were a case of life and
death. Every man must have a finger in what was going on, even to
cuffing the cabin-boy. The men squatted down upon deck to their
meals all in a group, and fell to cracking jokes and cutting capers
together. The helmsman sat in a chair to steer, and moved his seat
as often as he luffed or bore away. A little hop-off-my-thumb fellow,
with a comically dirty face and ragged breeches, sat upon a bucket
to watch the hour-glass in the binnacle. We had only seventy or
eighty miles to sail from Malta to Sicily, with a fair wind and a smooth
sea, but the fuss and clatter during the navigation of this short space
were prodigious. All hands were running fore and aft, looking out
ahead and astern, bustling around the man at the helm, peeping at
the compass, and jabbering and gesticulating as if they were in the
most imminent danger.
At daylight the next morning, we found ourselves close under the
Sicilian shore, with Mount Ætna in the north, towering up majestically
to the heavens, like a huge pyramid of snow with a black spot at the
top. It was more than seventy miles off. About ten in the forenoon we
arrived at Syracuse, a city which was once ten times as big as
Boston, but is now almost entirely depopulated. It has a noble
harbor, but we found only a few fishing-boats there; and when we
landed at the quay, hardly a living being was to be seen: everything
looked solitary, ruinous, and forlorn. I walked through the streets, but
saw no signs of trade, commerce, or industry. A few people were
sitting lazily before their doors, sunning themselves; and numbers of
beggars dogged my heels wherever I went. Now and then I met a
donkey with a pannier of greens, but no such thing as a wagon or
chaise.
When I got to the market-place, I saw groups of people sitting in
the sun or lounging idly about, but no business doing. I could not
help smiling to see a constable, who was strutting up and down to
keep the peace among this pack of lazy fellows. He wore a great,
long, tattered cloak, a huge cocked hat, a sword, and he had a most
flaming, fiery visage, with a nose like a blood-beet. I never saw such
a swaggering figure in my life, before. He happened to spy a little
urchin pilfering a bunch of greens, on which he caught him by the
nape of the neck with one hand, and drawing his sword with the
other, gave him a lusty thwacking with the flat of the blade. The little
rogue kicked and squalled, and made a most prodigious uproar,
which afforded great amusement to the crowd: they seemed to be
quite familiar with such adventures.
I walked out into the country, and was struck with astonishment at
the sight of the ruins scattered all round the neighborhood. They
extend for miles in every direction. Walls, arches, columns, remains
of temples, theatres and palaces met the eye at every step. Here
and there were little gardens among the ruins, where artichokes
were growing, but hardly a human being was to be seen. I came at
length to the remains of a large theatre, consisting of a semicircle of
stone steps, and found a mill stream tumbling down the middle of it.
A ragged peasant was lying lazily in the sun among the ruins. I
asked him what building it was, but he was totally ignorant of the
matter, and could only reply that it was “cosa antica”—something
ancient. Presently I discovered an enormous excavation in the solid
rock, as big as a house, which excited my curiosity very strongly. I
could not imagine the use of it, till I luckily met an old Capuchin friar,
plodding along in his coarse woollen gown; and learnt from him that
this was the famous “Ear of Dionysius,” where that tyrannical king
used to confine such persons as fell under his suspicion. It is a most
curious place, hollowed out in the shape of the human ear, and
forming a vast cavern: in the top is a little nook or chamber, where
the tyrant used to sit and hear what the prisoners said. The lowest
whisper was heard distinctly in this spot; so that the prisoners were
sure to betray themselves if they held any conversation together.
While I stood wondering at this strange perversion of human
ingenuity, I was startled by the appearance of a grim-looking fellow,
who pulled out a pistol as he approached me. My first impulse was to
grasp my trusty cudgel, and flourish it at him with a fierce air of
defiance, for I took him to be a robber, of course. To my surprise he
burst out a laughing, and told me he had come on purpose to show
me the wonderful effect of sound in the Ear. He bade me go into the
further end of the cavern, while he fired the pistol at the entrance. I
did so, and the effect was like the roaring of thunder: I was glad to
clap my hands to my ears and run out as fast as I could. I gave the
fellow a few cents for his trouble, and told him I had never before got
so much noise for so little money.
I continued to ramble about among the ruins, which seemed to
have no end. The almond trees were in full bloom, and the orange
trees were bowing down under loads of ripe fruit. Flocks of magpies
were flitting about, but everything was silent and deserted. Now and
then I met a countryman jogging lazily along upon a donkey, or an
old woman driving her beast with a load of vine-stalks, which are
used in the city to heat ovens. I could not help wondering to see so
fine a territory lie utterly neglected; but the indolence of the
inhabitants is the cause of all. A very little labor will earn a loaf of
bread, and most of them are satisfied with this. The climate is so
mild, that ragged clothes occasion no discomfort, and hardly
anybody minds going in rags. The soil is so rich as scarcely to
require art or industry in the cultivation. The oranges and the grapes
grow with hardly any care, and the husbandman lives a lazy life, with
but little to do except to pick the fruit and make the wine.
Sketches of the Manners, Customs, and History
of the Indians of America.
CHAPTER II.
The West Indies continued.—Discovery of Hayti.—Generosity of the
Cacique.—Testimony of Columbus in favor with the Indians.—
Character of the natives.—Columbus erects a cross.—Indian
belief.—Effect of the Spanish invasion.—The Cacique.
Something Wonderful.