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Chapter 3: Minimum Database for Intracranial Surgery 27

Figure 3.12 This is the penetrating bite wound shown in Figure 3.11. The
wound was cleaned by the initial treating veterinarian on the day of
the injury but no radiographs were taken. Intracranial abscess formation
leading to marked neurological deterioration occurred 72 hours later and
the patient was referred.

Figure 3.10 Lateral static fluoroscopic image of a dog shot in the craniocer-
vical area with a BB gun.

Figure 3.13 This is the wound from the same patient presented in
Figures 3.11 and 3.12. The skull defect is visible in the center of the surgical
field. Hair and fibrous tissue can be seen overlying the defect.

For the general practitioner, skull radiographs may be of great
value in determining the presence of foreign material or depressed
skull fragments. Although these may be difficult to obtain or inter-
pret, detection of these abnormalities on survey radiographs should
encourage prompt referral after patient stabilization. Immediate
surgical resolution of these wounds will prevent adhesions and
abscess formation. Surgical drainage is recommended for intracra-
Figure 3.11 Post‐contrast T1‐weighted MRI of a patient who was bitten on nial abscesses (Figures 3.11, 3.12 and 3.13). Cultures of the wound
the head 4 days earlier demonstrating intraaxial abscess with ring enhance- are best collected at the time of surgery and multiple samples
ment. The skull defect is visible. (including deep tissue samples rather than superficial wound
swabs) should be obtained. Perioperative antibiotics should be
these patients to avoid increases in ICP associated with excessive avoided until samples have been collected. Betadyne preps are
crystalloid administration. preferred as chlorhexidine carries a precaution of CNS toxicity.
It is vitally important to identify concurrent life‐threatening Indications for intracranial surgery after traumatic head injury
injuries such as cervical trauma, airway compromise, other ortho- include removal of penetrating foreign body, decompression of
pedic injuries, gastrointestinal issues, or diaphragmatic hernias depressed skull fracture fragments, or removal of a compressive hema-
(Figure 3.10). A full‐body CT scan may be the fastest way to make toma. The nature of the initial injury and the clinical and neurological
a complete assessment. However, it is prudent and more cost‐effective status of the patient may dictate the imaging modality selected (CT vs.
to use the neurological and physical examinations to guide selection MRI). Extraneural imaging is indicated in victims of polytrauma to
of appropriate body cavities for imaging. identify concurrent pulmonary, bladder, and spinal injury.