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- Author or Editor: Susan A. Arnold x
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Abstract
OBJECTIVE To assess the relationship between preoperative volume of primary intracranial gliomas in dogs as determined via MRI and survival time after surgical debulking and adjunctive immunotherapy.
DESIGN Retrospective cohort study.
ANIMALS 47 client-owned dogs enrolled in clinical trials regarding glioma treatments.
PROCEDURES Medical records of all dogs undergoing craniotomy at the University of Minnesota Veterinary Medicine Center with histologically confirmed glioma between 2008 and 2015 were retrospectively reviewed, and outcome data were collected. Preoperative T2-weighted or post–gadolinium administration T1-weighted MRI scans, performed at several referral institutions with scanners of magnet strengths ranging from 0.5 to 3.0 T, were used to measure tumor volumes as a percentage of total calvarial volume. Data were analyzed to assess the effect of each 2% fraction of tumor volume on median survival time (MST) after surgery and adjuvant treatment.
RESULTS Tumor volumes ranged from 0.5% to 12.2% of total intracranial volume. Overall MST was 185 days (range, 2 to 802 days). No association was identified between preoperative tumor volume and MST. Only 3 (6%) dogs had low-grade tumors that had relatively small volumes, measuring 1.4%, 2.1%, and 4.3% of total calvarial volume. The MST for these 3 dogs (727 days) was longer than that for high-grade tumors (174 days); however, owing to the low number of dogs with low-grade tumors, no statistical comparison was performed.
CONCLUSIONS AND CLINICAL RELEVANCE Preoperative tumor volume determined via MRI was neither associated with nor predictive of outcome following surgery and adjunctive treatment for dogs with glioma. Tumor grade was predictive of outcome, but unlike tumor volume that was measured with MRI, invasive biopsy was necessary to definitively diagnose tumor grade.
Abstract
OBJECTIVE To determine incidence of and risk factors for major complications occurring in dogs within 30 days after cytoreductive surgery performed by a single pair of surgeons for treatment of suspected primary intracranial masses.
DESIGN Retrospective cohort study.
ANIMALS 160 client-owned dogs that underwent cytoreductive surgery for treatment of suspected primary intracranial masses between January 2009 and December 2015 at a veterinary teaching hospital.
PROCEDURES Medical records were retrospectively reviewed for complications occurring within 30 days after surgery. Data (eg, signalment, clinical signs, previous treatments, preoperative neurologic examination findings, neuroanatomical location, time from onset of clinical signs to surgery, surgical approach, and histopathologic diagnosis) were analyzed for associations with death and with development of major complications other than death.
RESULTS 21 (13.1%) dogs died (11 during hospitalization and 10 after discharge) and 30 (18.8%) developed major complications other than death during the first 30 days after surgery. Dogs with abnormal preoperative neurologic examination findings were more likely to develop complications or die. Dogs undergoing a suboccipital approach were more likely to die. The most common postoperative complications other than death were seizures (n = 18 [11.3%]), worsening of neurologic status (6 [3.8%]), and aspiration pneumonia (6 [3.8%]).
CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study provided valuable information on predisposing factors, odds of major complications or death, and incidences of major complications or death in dogs during the first 30 days after undergoing cytoreductive surgery for treatment of suspected primary intracranial masses. Careful case selection may help improve outcomes and minimize complications.
Abstract
CASE DESCRIPTION
3 dogs were examined because of a sudden onset of signs of pain (1 dog) or paraparesis (2 dogs).
CLINICAL FINDINGS
Neurologic findings consisted of myelopathy affecting the lumbar intumescence (1 dog) and T3-L3 myelopathy (2 dogs). In all dogs, MRI revealed spinal cord compression caused by L3-4 disk herniation. All dogs underwent routine surgical decompression of the intervertebral disk herniation. During MRI and decompressive surgery, physiologic variables were monitored. Immediately after surgery, all dogs were paraplegic with pelvic limb neurologic dysfunction consistent with myelopathy affecting the L4 through caudal spinal cord segments.
TREATMENT AND OUTCOME
Within 24 hours after surgery, repeated MRI in all dogs revealed hyperintensity in the spinal cord gray matter of the lumbar intumescence on T2-weighted images. In the absence of neurologic improvement, dogs were euthanized at 3, 91, and 34 days after surgery. Postmortem microscopic examination of each dog's spinal cord at the lumbar intumescence revealed necrosis of the gray matter with relative white matter preservation suggestive of an ischemic injury.
CLINICAL RELEVANCE
Dramatic neurologic deterioration following decompressive surgery for intervertebral disk herniation in dogs may be associated with the development of poliomyelomalacia secondary to ischemia. In these 3 dogs, ischemia developed despite probable maintenance of normal spinal cord blood flow and perfusion during anesthesia. To exclude other causes, such as compression or hemorrhage, MRI was repeated and revealed hyperintensity of the spinal cord gray matter on T2-weighted images, which microscopically corresponded with ischemic neurons and neuronal loss.
