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114 Section II: Intracranial Procedures

Figure 11.12 A polypropylene mesh is placed over the craniectomy site.
This material is biologically inert and can be attached to the borders of
the craniectomy using small drill holes and 2‐0 absorbable or nonabsorbable
Figure 11.11 A dural substitute material (arrow) has been placed over the monofilament sutures or can be sutured to the thin fascia underlying the
cortical tissue. This material can be used with the remaining dura or by itself temporalis muscle.
as a scaffolding for regrowth of the dura.

for any continued hemorrhage. Closure begins with a dural cover-
ing. Most often the dura is torn, can contain neoplastic cells, or is Video clips to accompany this book can be found on
otherwise inadequate for complete coverage of the exposed cortical the companion website at:
tissue. A dural substitute can be fashioned from the temporalis www.wiley.com/go/shores/neurosurgery
muscle fascia or a commercially available product (DuraGen®,
Integra Corporation; ACell Vet®, ACell, Inc.; Biodesign® Dural
Graft; COOK® Biotech) is used (Figure 11.11). If the dura or dural References
substitute is sutured, 5‐0 or 6‐0 absorbable monofilament suture is 1 Oliver JE Jr. Canine cranial surgery. Thesis, Auburn University, 1966.
used in a simple interrupted pattern. 2 Oliver JE Jr. Cranial surgery. In: Oliver JE, Hoerlein BF, Mayhew IG (eds) Veterinary
Neurology. Philadelphia, PA: WB Saunders, 1987: 470–492.
Generally, the bone flap is not replaced since there is adequate 3 Shores A, Cooper TG, Gartrell CL et al. Cerebrovascular disease in small animals:
muscle covering; however, if replaced, 2‐0 absorbable or nonab- clinical characteristics. In: Proceedings of the 9th Annual Veterinary Medical Forum,
sorbable sutures are placed in holes drilled into the bone flap and New Orleans, May 1991. Lakewood, CO: American College of Veterinary Internal
the connecting area of the skull. An alternative used by the author is Medicine, 1991: 777–780.
a polypropylene mesh to cover the defect (Figure 11.12). The mesh 4 Bagley RS. Brain. In: Slatter D (ed.) Textbook of Veterinary Surgery, 3rd edn.
Philadelphia, PA: WB Saunders, 2003: 1163–1173.
can be sutured to the bone as described for flap replacement or to 5 Shores A, Holland M, Hudson J. Intraoperative ultrasound for intracranial surgery.
the fascia underneath the temporalis muscle. In: McFarlane D, Sellon R (eds) Proceedings of the American College of Veterinary
The incised temporalis muscle fascia is sutured to remaining Internal Medicine Forum 2012. Lakewood, CO: American College of Veterinary
temporalis fascia attached to the skull. The overlying interscutu- Internal Medicine, 2012. Available at http://www.vin.com/acvim/2012/Default.htm
larias muscle, other subcutaneous tissue, and the skin are closed to 6 Chen AV, Wininger FA, Frey S et al. Description and validation of a magnetic reso-
nance imaging‐guided stereotactic brain biopsy device in the dog. Vet Radiol
complete the procedure. Ultrasound 2012;53:150–156.