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Chapter 3: Minimum Database for Intracranial Surgery 25

biopsy before neurosurgical intervention must be weighed and craniectomy patients are at high risk of aspiration pneumonia in the
discussed with the client (Figure 3.4). perioperative period. Thoracic radiographs also allow estimation of
Preprandial and postprandial bile acid concentrations are heart size and shape and pulmonary changes associated with cardiac
indicated when liver abnormalities are identified ultrasonographi- disease. Since cardiovascular disease may increase anesthetic mor-
cally or when liver function is questionable based on abnormalities bidity, this additional information is helpful in patients with cardiac
in the chemistry profile. If liver function is abnormal, a clotting abnormalities undergoing intracranial surgery (Figures 3.8 and 3.9).
profile is warranted and surgery may be postponed. A coagulation Recent serum concentrations should be available for any patient
profile is indicated in patients with known or suspected clotting with a seizure disorder, as dose adjustments are required. The anti-
disorder. Dobermans that have not been evaluated for von convulsant medications phenobarbital and levetiracetam may have
Willebrand’s disease should be tested and a buccal mucosal bleed-
ing time should always be performed prior to surgery (Figures 3.5
and 3.6). If coagulation abnormalities are identified, appropriate
blood products should be available for transfusion if needed.
Bleeding is a significant concern associated with removal of
tumors located near the venous sinuses (e.g., meningiomas). All
these patients should be blood typed and/or cross‐matched prior to
surgery.
In addition to documenting primary or metastatic pulmonary dis-
eases, thoracic radiographs are useful as a baseline for detection and
monitoring of aspiration pneumonia (Figure 3.7). Craniotomy/

Figure 3.6 Blood is blotted with filter paper without touching the incisions
until a clot is formed. Normal time for platelet plug formation and cessation
of bleeding should be less than 4 min.

Figure 3.4 Four months later when the patient in Figure 3.3 was euthanized
from complications associated with radiation therapy, histopathology
revealed hepatocellular adenocarcinoma.

Figure 3.7 This ventrodorsal radiograph shows a diffuse interstitial pattern
Figure 3.5 Two small incisions (5 × 1 mm) created by a spring‐loaded lancet with consolidation of the left middle lung lobe most consistent with aspira-
placed on the mucosa of the upper lip. tion pneumonia.