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Craniotomy

A craniotomy is a procedure that involves creating an entry into the skull to access the structures within the cranium such as the brain, meninges, ventricular system, and nerve roots. Conditions that require a craniotomy procedure may involve surgical removal of brain tumors, brain biopsies, relieving hemorrhage, or compression due to foreign body or trauma. Depending on the location of the condition where the access needs to be created, the approach of the craniotomy procedure varies. Craniotomies need to be carefully and diligently planned. Planning involves advanced imaging such as magnetic resonance imaging (MRI) of the brain and usually in conjunction with computed tomography (CT).

Chiari-like Malformation and Foramen Magnum Decompression:

The anatomy of certain breeds such as the Cavalier King Charles Spaniel and Brussels Griffon predispose them to a condition called Chiari-like Malformation. This is a condition in which the shortening of the soft palate of the mouth and the malformation of the occipital bone at the back of the skull in combination results in inadequate space within the back part of the skull. Due to inadequate space, brain structures residing at the back of the skull, namely the cerebellum, are compressed and this results in herniation of a part of the cerebellum out towards the back of the skull. This condition is also associated with the blockage of cerebrospinal fluid (CSF) flow from the ventricular system within the brain towards the spinal cord. When the natural flow of CSF is obstructed, this fluid builds up within the ventricular system causes the ventricular system to dilate and push onto structures of the brain. In addition, fluid also accumulates abnormally within the spinal cord, a condition called syringohydromyelia, and causes abnormal sensation or pain in the neck and/or back. The symptoms of Chiari-like Malformation is neck pain, phantom scratching of the neck, loss of balance that may be episodic, and even seizures. Diagnosis of this condition involves a brain MRI.

If a patient is a candidate for surgical remedy, a procedure called a foramen-magnum decompression is performed. In this procedure, a section of the occipital bone that is compressing onto the cerebellum is removed, along with a section of the atlas, the first cervical vertebra. This allows for the cerebellum to be decompressed and the establishes an improved flow of CSF, thus preventing further building of CSF within the ventricular system and the spinal cord. The goal of the surgery is to relieve/improve clinical signs and prevent further decline.

Ventriculoperitoneal Shunt Placement

This particular procedure involves placement of a tube to shunt cerebrospinal fluid (CSF) away from the brain and into the abdomen to be absorbed. This procedure is employed when there is a buildup of CSF either within the ventricular system or if there is formation of an abnormal cystic structure called the intracranial arachnoid cyst.
Neurosurgery Involving Conditions of the Brain: