Dewey Curtis W, Krotscheck Ursula, Bailey Kerry S, Marino Dominic J
Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA.
Vet Surg. 2007 Jul;36(5):416-22. doi: 10.1111/j.1532-950X.2007.00287.x.
To describe a technique of decompressive craniotomy with cystoperitoneal shunt (CPS) placement for treatment of canine intracranial arachnoid cyst (IAC), and to evaluate outcome in 4 dogs.
Retrospective study.
Dogs (n=4) with IAC.
Medical records of dogs diagnosed with IAC by magnetic resonance imaging (MRI; 3 dogs) or computed tomography (CT; 1 dog) were evaluated. All dogs had varying degrees of neurologic dysfunction before surgery. A combined lateral (rostrotentorial)/suboccipital craniotomy was performed sacrificing the transverse sinus on the operated side. The rostral (ventricular) end of a low-pressure valve shunt (3.0 mm outer diameter, 7.0 cm length) was placed transversely into the cyst cavity; the distal end was placed in the peritoneal cavity. All dogs were rechecked at various intervals by >or=1 of the authors either directly, by telephone consultation with owners, or both. Three dogs were imaged postoperatively (CT-1 dog; MRI-1; ultrasonography-1).
Intraoperative complications were limited to excessive transverse sinus hemorrhage requiring blood transfusion in 1 dog. There were no postoperative complications. Clinical signs of neurologic dysfunction resolved in 3 dogs and improved substantially in 1 dog. The latter dog required long-term, low-dose corticosteroid therapy. No dogs required repeat surgery. Mean follow-up time was 23.8 months (range, 12-43 months). Collapse of the intracranial cyst was verified in 3 dogs with repeat imaging. In 2 dogs, there was no evidence of the cyst on CT or MRI; in the third dog, a small amount of fluid was demonstrated rostral to the cerebellum on ultrasonography, but there was no identifiable cyst. In 1 dog, the rostral aspect of the shunt had shifted; however, this was not associated with any clinical deterioration.
Craniotomy with CPS placement was well tolerated and resulted in sustained improvement or resolution of dysfunction. Cyst decompression was verified in 3 dogs that were re-imaged. None of the patients required re-operation. Excessive transverse sinus hemorrhage is a potential danger that may necessitate blood transfusion. Other IAC patients treated with this method will need to be evaluated to fully evaluate its effectiveness.
Craniotomy with CPS placement may be an effective treatment method for dogs clinically affected with IAC.
描述一种通过放置囊肿-腹腔分流术（CPS）进行减压颅骨切开术治疗犬颅内蛛网膜囊肿（IAC）的技术，并评估4只犬的治疗效果。
回顾性研究。
患有IAC的犬（n = 4）。
评估通过磁共振成像（MRI；3只犬）或计算机断层扫描（CT；1只犬）诊断为IAC的犬的病历。所有犬在手术前均有不同程度的神经功能障碍。进行联合外侧（额颞叶）/枕下颅骨切开术，牺牲手术侧的横窦。将低压瓣膜分流器（外径3.0 mm，长度7.0 cm）的头端（脑室端）横向置入囊肿腔内；尾端置入腹腔。所有犬由至少1名作者在不同时间间隔通过直接检查、与犬主电话咨询或两者结合的方式进行复查。3只犬术后进行了影像学检查（CT - 1只犬；MRI - 1只犬；超声检查 - 1只犬）。
术中并发症仅限于1只犬出现横窦出血过多需要输血。无术后并发症。3只犬神经功能障碍的临床症状消失，1只犬症状明显改善。后一只犬需要长期、低剂量的皮质类固醇治疗。无犬需要再次手术。平均随访时间为23.8个月（范围12 - 43个月）。3只犬通过重复影像学检查证实颅内囊肿塌陷。2只犬在CT或MRI上未发现囊肿迹象；第三只犬在超声检查中显示小脑前方有少量液体，但未发现明确囊肿。1只犬分流器的头端发生移位；然而，这与任何临床恶化无关。
放置CPS的颅骨切开术耐受性良好，可使功能持续改善或恢复。3只复查犬证实囊肿减压。无患者需要再次手术。横窦出血过多是一种潜在风险，可能需要输血。需要对其他采用该方法治疗的IAC患者进行评估，以全面评估其有效性。
放置CPS的颅骨切开术可能是临床患有IAC的犬的一种有效治疗方法。
