Intracranial Surgery: Combined Approaches to the Brain and Cranioplasty

Presentation Description / Summary: Common avenues for canine and feline brain surgery are the lateral, frontal and caudal approaches to the brain. These avenues are designed to primarily avoid large vascular structures, such as the dorsal sagittal sinus and transverse sinuses. Additionally, the avenues maintain the shape of the skull. Oftentimes, we encounter intracranial or extracranial neoplasia or malformations, which require a more robust dissection in order to remove the abnormality as completely as possible while also aiming for the best margins possible. This may involve combining approaches and often requires cranioplasty to reconstruct the skull. In this presentation we will discuss combined approaches including the combined rostral - lateral, dorsal (lateral to latera) and combined caudal - lateral approaches. In addition, we will discuss methods to avoid cranioplasty by preserving essential elements of the skull and when necessary, reconstruct the skull using titanium mesh. The practical guide will allow neurosurgeon the ability to confidently approach large intracranial and extracranial masses, as well as malformations in a manner which is safer for the patient and easier for the neurosurgeon. The lecture will describe various techniques with case examples to support the descriptions. This is considered an advanced neurosurgery lecture.

Learner Outcomes: 1. The attendee will evaluate advanced imaging of the patient and analyze the most successful surgical approach to the abnormality. 2. The attendee will understand when and what limitations are necessary for ligation of the dorsal sagittal sinus. 3. The attendee will understand how to approach and safely occlude one of the transverse sinuses of the skull. 4. The attendee will be able to determine when various approaches to the brain can be combined. 5. The attendee will understand the fundamental elements necessary for cranioplasty, when to do it and when it can be avoided.