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Chapter 10: Transfrontal Craniotomy 107
lateral ventricles. CT can clearly demonstrate intracranial air bub 7 Tapp PD, Siwak CT, Gao FQ et al. Frontal lobe volume, function, and beta‐amyloid
bles or a porencephalic cyst near the site of a fistula [31]. CT cister pathology in a canine model of aging. J Neurosci 2004;24:8205–8213.
nography helps directly visualize contrast passing through defects 8 Foster ES, Carrillo JM, Patnaik AK. Clinical signs of tumors affecting the rostral
cerebrum in 43 dogs. J Vet Intern Med 1988;2:71–74.
in the skull [32]. MRI can offer another alternative to these imaging 9 Patnaik AK, Lieberman PH, Erlandson RA, Shaker E, Hurvitz AI. Paranasal men
techniques. Air within the ventricles is visible as a signal void on ingioma in the dog: a clinicopathologic study of ten cases. Vet Pathol 1986;23:
both T1‐weighted and T2‐weighted images (Figure 10.18) [27]. 362–368.
Management of asymptomatic pneumocephalus when associated 10 Kostolich M, Dulisch ML. Surgical approach to the canine olfactory bulb for men
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with trauma or surgery might be rest and close monitoring. 11 Parker AJ, Cunningham JG. Transfrontal craniotomy in the dog. Vet Rec
However, if clinical signs progress, a medical or surgical procedure 1972;90:622–624.
should be initiated. Supplemental oxygen to increase the rate of 12 DeWet PD, Ali II, Peterson DN. Surgical approach to the rostral cranial fossa by
absorption of intracranial air is a common human neurosurgical radical transfrontal craniotomy in the dog. J S Afr Vet Assoc 1982;53:40–41.
practice. Surgical therapy for hypertensive pneumocephalus con 13 Glass EN, Kapatkin AS, Vite CH, Steinberg SA. A modified bilateral transfrontal
sists of relieving the tension within the cavity and closure of the sinus approach to the canine frontal lobe and olfactory bulb: surgical technique and
five cases. J Am Anim Hosp Assoc 2000;36:43–50.
dural tear. It had been reported that dead spaces and fistulae can be 14 Uriarte A, Moissonnier P, Thibaud JL et al. Surgical treatment and radiation ther
treated by closing them with a free graft of temporalis fascia, with apy of frontal lobe meningiomas in 7 dogs. Can Vet J 2011;7:748–752.
fat [10], or hemostatic sponges [28]. This should limit desiccation 15 Cabassu JB, Cabassu JP, Brochier L, Catheland S, Ivanoff S. Surgical treatment of a
of the brain parenchyma in contact with air in the frontal sinuses traumatic intracranial epidural haematoma in a dog. Vet Comp Orthop Traumatol
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and prevent further entry of air into the ventricles or leakage of CSF. 16 Garosi LS, Platt SR, McConnell JF, Wray JD, Smith KC. Intracranial haemorrhage
Closure of a craniotomy flap involves placing 22‐ to 24‐gauge stain associated with Angiostrongylus vasorum infection in three dogs. J Small Anim
less steel orthopedic wire or size 0 to 2‐0 nonabsorbable monofilament Pract 2005;46:93–99.
suture materials through predrilled holes at strategic locations around 17 Summers BA, Cummings JF, de Lahunta A. Injuries to the central nervous system.
In: Veterinary Neuropathology. St Louis, MO: Mosby Year Book, 1995: 189–207.
the bone fragment [11,13]. Alternatively, the use of interlaced suture 18 Dewey C, Downs M, Aron D et al. Acute traumatic intracranial hemorrhage in
to lace or suspend the bone flap has also been described. Although dogs and cats: a retrospective evaluation of 23 cases. Vet Comp Orthop Traumatol
inexpensive in their implementation, these techniques can be associ 1993;6:153–159.
ated with disadvantages like bone fragment sequestration and mate 19 Tan Y, Zhou S, Liu Y, Li Z. A gross and microscopic study of cerebral injuries
rial breakdown. Use of a rivet‐like titanium clamp closure system to accompanying maxillofacial high‐velocity projectile wounding in dogs. J Oral
Maxillofac Surg 1998;56:345–348.
replace an external frontal bone flap after transfrontal craniotomy has 20 Haley AC, Abramson C. Traumatic pneumocephalus in a dog. J Am Vet Med Assoc
been described. This technique enhances stability, reduces surgical 2009;234:1295–1298.
time, and the clamps are MRI compatible but the system is expensive 21 Kasper EM, Bartek J Jr, Johnson S, Kasper BS, Pavlakis M, Wong M. Post‐transplant
and requires specific instrumentation [33]. aspergillosis and the role of combined neurosurgical and antifungal therapies
under belatacept immunosuppression. Surg Neurol Int 2011;2:75.
There are some situations where the craniotomy flap cannot be 22 de Lahunta A, Glass E. Development of the nervous system: malformation. In:
replaced, such as when there is bone pathology (hyperostosis) or Veterinary Neuroanatomy and Clinical Neurology, 3rd edn. St Louis, MO: Saunders
the bone has been damaged during the drilling. In the case series Elsevier, 2009: 40.
of Uriarte et al. [14], a PMMA prosthesis was placed to cover the 23 Jeffery N. Ethmoidal encephalocoele associated with seizures in a puppy. J Small
Anim Pract 2005;46:89–92.
bony defect created by the transfrontal approach, as the bone flap 24 Martlé VA, Caemaert J, Tshamala M et al. Surgical treatment of a canine intranasal
could not be restituted. In our hospital, we have used this tech meningoencephalocele. Vet Surg 2009;38:515–519.
nique for replacement of craniotomy defects without any compli 25 Carreira LM, Ferreira A, Burilo FL. The dorsal sagittal venous sinus anatomical
cations to date. variations in brachycephalic, dolichocephalic, and mesocephalic dogs and their sig
nificance for brain surgery. Anat Rec 2011;294:1920–1929.
26 Fransson BA, Bagley RS, Gay JM et al. Pneumonia after intracranial surgery in
Video clips to accompany this book can be found on dogs. Vet Surg 2001;30:432–439.
the companion website at: 27 Garosi LS, Penderis J, Brearley MJ, Brearley JC, Dennis R, Kirkpatrick PJ.
Intraventricular tension pneumocephalus as a complication of transfrontal craniec
www.wiley.com/go/shores/neurosurgery tomy: a case report. Vet Surg 2002;31:226–231.
28 Cavanaugh RP, Aiken SW, Schatzberg SJ. Intraventricular tension pneumocephalus
and cervical subarachnoid pneumorrhachis in a bull mastiff dog after craniotomy.
J Small Anim Pract 2008;49:244–248.
References 29 Fletcher, DJ, Snyder JM, Messinger SJ, Chiu AG, Vite CH. Ventricular pneumo
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