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Ventriculoperitoneal Shunting for Brain Tumors
Brain tumors exert their clinical effects in a variety of ways. Mass effect, edema, seizures, and a vicious cycle of cause and effect are often the focus of therapeutic interventions employed to improve clinical signs and increase survival time. Obstructi... moreBrain tumors exert their clinical effects in a variety of ways. Mass effect, edema, seizures, and a vicious cycle of cause and effect are often the focus of therapeutic interventions employed to improve clinical signs and increase survival time. Obstructive hydrocephalus is a common sequela of certain types of brain tumors and is often the major driver of clinical signs seen in tumors arising within the ventricular system. This study outlines the application of ventriculoperitoneal shunting for obstructive hydrocephalus secondary to brain tumors as part of an overall management program to help increase patients’ lifespan and quality of life. less
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Intraoperative Ultrasound in Brain Surgery
This study describes the essential components and the technique of intraoperative ultrasound (IOUS), including probe selection and techniques used to produce quality images. Case examples are given to illustrate the value and the accuracy of IOUS in intra... moreThis study describes the essential components and the technique of intraoperative ultrasound (IOUS), including probe selection and techniques used to produce quality images. Case examples are given to illustrate the value and the accuracy of IOUS in intracranial surgery of companion animals. IOUS has proven an invaluable addition to intracranial surgery, especially in real-time localization of the mass, identifying borders between mass and normal cerebral tissue, and identifying vascular supply to the mass. less
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Novel Treatments for Brain Tumors
The blood–brain barrier and knowledge gaps in tumor biology remain significant obstacles to the development of effective treatments for brain tumors. The identification of shared molecular and genetic pathways that contribute to tumorigenesis in both dogs... moreThe blood–brain barrier and knowledge gaps in tumor biology remain significant obstacles to the development of effective treatments for brain tumors. The identification of shared molecular and genetic pathways that contribute to tumorigenesis in both dogs and people has been key to the discovery and translation of targeted pharmacologic and biologic therapies. Treatment approaches often utilize targeted or multifunctional antitumor agents, such as nanocarriers, molecularly targeted agents, immunotherapeutics, and oncolytic viruses in combination with alternative therapeutic delivery strategies. The article discusses about various treatments albeit none of the treatments discussed here are widely available or approved for clinical use. less
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Radiation Therapy for Brain Tumors in Dogs and Cats
External beam radiation therapy (RT) has become the standard of care for non-resectable or post-operative incompletely excised brain tumors in dogs and cats due to its relatively low side effect profile and increasing availability. This article reviews th... moreExternal beam radiation therapy (RT) has become the standard of care for non-resectable or post-operative incompletely excised brain tumors in dogs and cats due to its relatively low side effect profile and increasing availability. This article reviews the indications for, expected outcomes of and possible toxicities associated with RT, follow-up care recommendations after RT, and publications about specific tumor types in dogs and cats with brain tumors.
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Complications in Intracranial Surgery of Companion Animals
The most common complications of intracranial surgery in companion animals chiefly consist of brain swelling, hemorrhage, seizures, and worsening of neurologic status, aspiration pneumonia, and anesthetic death. Further dividing these into intraoperative ... moreThe most common complications of intracranial surgery in companion animals chiefly consist of brain swelling, hemorrhage, seizures, and worsening of neurologic status, aspiration pneumonia, and anesthetic death. Further dividing these into intraoperative and postoperative complications, postoperative are more common. Preventative measures can include careful surgical planning, cerebro-protective anesthetic regimes, seizure prophylaxis, and postoperative sedation/pain management that allows for an early return to function and ambulation and an adequate and accelerated nutrition. less
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Biopsy of Brain Lesions
Brain biopsy is essential for accurate diagnosis but is frequently avoided in veterinary medicine because of doubts about its safety, reliability, and clinical value. Data available from human and veterinary investigations suggest that such doubts are lar... moreBrain biopsy is essential for accurate diagnosis but is frequently avoided in veterinary medicine because of doubts about its safety, reliability, and clinical value. Data available from human and veterinary investigations suggest that such doubts are largely unwarranted. Many devices are available to guide minimally invasive biopsy but some can be costly to purchase and use, which can be problematic in veterinary medicine. Nowadays, costs can be substantially reduced by using 3-dimensional-printed guides. less
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MRI Characteristics of Primary Brain Tumors and Advanced Diagnostic Imaging Techniques
Extensive descriptions of MRI characteristics of canine and feline brain tumors allow for relatively accurate lesion detection, discrimination, and presumptive diagnosis on MRI. Ambiguous and overlapping MRI features between brain lesion and tumor as well... moreExtensive descriptions of MRI characteristics of canine and feline brain tumors allow for relatively accurate lesion detection, discrimination, and presumptive diagnosis on MRI. Ambiguous and overlapping MRI features between brain lesion and tumor as well as tumor types is a limitation that necessitates histopathology for final diagnosis, which is often not available antemortem. Non-invasive advanced diagnostic imaging techniques continue to be developed to enhance sensitivity and specificity for brain tumor diagnosis on MRI in dogs and cats. less
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Brain MRI Protocol and Systematic Approach to Interpretation of Brain Tumors on MRI
MRI plays an integral role in the diagnosis of brain tumors in dogs and cats. Optimized image acquisition protocols in addition to a systematic approach to brain tumor evaluation on MRI using imaging characteristic interpretation criteria may allow for en... moreMRI plays an integral role in the diagnosis of brain tumors in dogs and cats. Optimized image acquisition protocols in addition to a systematic approach to brain tumor evaluation on MRI using imaging characteristic interpretation criteria may allow for enhanced lesion detection, accurate presumptive diagnoses, and formulation of a prioritized differential diagnosis list.
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Update on Diagnosis and Treatment of Brain Tumors in Dogs and Cats
I am excited to present a new issue of Veterinary Clinics of North America: Small Animal Practice featuring the diagnosis and treatment of brain tumors in dogs and cats. When I have a patient with a brain lesion, I often think of Harvey Cushing, who at th... moreI am excited to present a new issue of Veterinary Clinics of North America: Small Animal Practice featuring the diagnosis and treatment of brain tumors in dogs and cats. When I have a patient with a brain lesion, I often think of Harvey Cushing, who at the beginning of the twentieth century with help of a thorough neurologic examination was able to localize the exact location of a lesion without the help of any diagnostic imaging or even an X ray. He performed over 2000 procedures, including brain surgeries, during his career, and by inventing new instruments, such as vascular clips to prevent hemorrhage, improving instruments and developing his surgical technique, the mortality for brain surgeries was reduced from 50% to 10%. less
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Updates on Radiation Therapy for Pituitary Tumors
Radiation therapy for the treatment of both functional and nonfunctional pituitary tumors for dogs and cats has been described in veterinary medicine with a recent shift in focus toward stereotactic techniques. While the technology required and normal tis... moreRadiation therapy for the treatment of both functional and nonfunctional pituitary tumors for dogs and cats has been described in veterinary medicine with a recent shift in focus toward stereotactic techniques. While the technology required and normal tissue constraints for stereotactic procedures are more stringent, recent publications indicate that, while it helps alleviate clinical signs, the survival response may not be as durable as with conventionally fractionated radiation therapy in dogs, despite being seen in cats. Regardless of the protocol recommendation, potential benefit to the patient is excellent with manageable side effect profiles. less
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Skeletal Muscle Biopsy
Muscle biopsy is often required to provide a definitive diagnosis for neuromuscular disorders and can be performed using open surgical or percutaneous needle biopsy techniques. Fresh samples that are subsequently frozen in the laboratory are preferred by ... moreMuscle biopsy is often required to provide a definitive diagnosis for neuromuscular disorders and can be performed using open surgical or percutaneous needle biopsy techniques. Fresh samples that are subsequently frozen in the laboratory are preferred by laboratories engaged in research, whereas formalin-fixed muscle is processed by diagnostic laboratories with specialized tinctorial and immunohistochemical techniques. Interpretation by an experienced histopathologist, combined with the signalment, history, and clinical input, is essential for establishing a diagnosis. This article outlines best practices to select, obtain, and ship a muscle sample to a laboratory and a summary of laboratory techniques. less
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Equine Oncology: Why Does It Matter Anyway?
Whilst I would be the first to admit that oncology is not generally considered to be the most important field within equine medicine, this underserved area is growing in understanding, and the treatment options are often varied and complex with very littl... moreWhilst I would be the first to admit that oncology is not generally considered to be the most important field within equine medicine, this underserved area is growing in understanding, and the treatment options are often varied and complex with very little evidence behind many of the traditional approaches. New treatments are being investigated all the time, and as owners demand better treatment options for their horses, practitioners need to be at the forefront of these developments to best advise the management of these sometimes-complicated cases. less
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Unusual Equine Tumors
There are a number of unusual tumors in the horse. Gross tumor characteristics, anatomical location, and signalment may assist with identification. Clinical pathology is often unrewarding with non-specific findings, while fine needle aspirates may not obt... moreThere are a number of unusual tumors in the horse. Gross tumor characteristics, anatomical location, and signalment may assist with identification. Clinical pathology is often unrewarding with non-specific findings, while fine needle aspirates may not obtain sufficient tissue material to confirm a diagnosis. Although regular staining of biopsy material may be sufficient, immunohistochemistry markers may be required, especially in less differentiated tumors. The prognosis is dependent on the type, location, tumor size as well as on metastatic spread. A selection of unusual and rare tumors that the clinician is more likely to encounter is discussed. less
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Lymphoma & Myeloproliferative Disease
Lymphoma and myeloproliferative diseases in horses are relatively uncommon. The clinical signs, prognosis, and treatment options depend upon the anatomic location and subtype. Significant gaps in knowledge remain regarding prevalence, pathogenesis of diff... moreLymphoma and myeloproliferative diseases in horses are relatively uncommon. The clinical signs, prognosis, and treatment options depend upon the anatomic location and subtype. Significant gaps in knowledge remain regarding prevalence, pathogenesis of different subtypes, antemortem diagnostic tests, response to treatment, and standardized treatment protocols. However, treatment options are available, accessible on the farm, and could improve quality of life and prolong survival.
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Equine Melanoma Updates
Melanomas are very common in older gray horses, with 80% of gray horses having at least 1 melanoma by 15 years of age. Historically considered a benign disease, it is now known that up to 66% of lesions will eventually metastasize. Melanomas may also caus... moreMelanomas are very common in older gray horses, with 80% of gray horses having at least 1 melanoma by 15 years of age. Historically considered a benign disease, it is now known that up to 66% of lesions will eventually metastasize. Melanomas may also cause local problems due to abscessation, ulceration, and interference with function of the affected areas. Treatment can be limited by size and location, but surgical resection, where possible, is likely to be the treatment of choice.
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Surgical Management of Equine Neoplasia
Equine neoplasia poses challenges in surgical management owing to their diverse locations and potential for aggressive behavior. Surgical interventions aim for complete excision while minimizing cosmetic and functional impairments. Techniques such as lase... moreEquine neoplasia poses challenges in surgical management owing to their diverse locations and potential for aggressive behavior. Surgical interventions aim for complete excision while minimizing cosmetic and functional impairments. Techniques such as laser ablation and electrochemotherapy offer minimally invasive options for accessible tumors. For deeper or larger masses, surgical excision with adequate margins remains the gold standard. Preoperative biopsy and imaging guides surgical planning, ensuring complete tumor removal while preserving vital structures. Close adherence to a strict surgical protocol to prevent seeding of tumor cells, and, where possible, appropriate skin reconstruction techniques will improve cosmesis and outcome. less
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Diagnosis and Staging of Equine Neoplasia
The diagnosis of neoplasia in the horse is both simple and extremely challenging, depending on the type of neoplasm and its location. Obtaining an accurate diagnosis of a neoplastic condition is key to formulating an appropriate treatment plan if possible... moreThe diagnosis of neoplasia in the horse is both simple and extremely challenging, depending on the type of neoplasm and its location. Obtaining an accurate diagnosis of a neoplastic condition is key to formulating an appropriate treatment plan if possible or developing a palliative plan if curative treatment options do not exist. A combination of historical features, clinical examination findings, and diagnostic testing typically allow a working diagnosis of neoplasia to be made, with a definitive diagnosis requiring the identification of neoplastic cells in a sample or tissue. less
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Tumors of the Respiratory Tract
Thoracic neoplasia often presents with generalized and nonspecific clinical signs and should be considered as a differential especially when patients are nonresponsive to therapeutic intervention for more common differential diagnoses of respiratory disea... moreThoracic neoplasia often presents with generalized and nonspecific clinical signs and should be considered as a differential especially when patients are nonresponsive to therapeutic intervention for more common differential diagnoses of respiratory disease (such as equine asthma) and where there is evidence thoracic and/or abdominal effusion upon examination. Antemortem diagnosis can be challenging and working closely with a pathologist to differentiate the respective neoplasia is helpful. Early recognition and appropriate management of thoracic neoplasia are vital for patient welfare as rapid disease progression can be relatively quick, and/or the relatively advanced stage of disease in which these patients frequently present. less
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Oral and Sinonasal Tumors
This article reviews the different types of equine non-neoplastic and neoplastic oral and sinonasal tumors and describes their known prevalence and general characteristics. The clinical and ancillary diagnostic findings (primarily radiography and endoscop... moreThis article reviews the different types of equine non-neoplastic and neoplastic oral and sinonasal tumors and describes their known prevalence and general characteristics. The clinical and ancillary diagnostic findings (primarily radiography and endoscopy, and increasingly computed tomography) for each type of growth that can aid diagnosis are described. Most lesions require a histopathological confirmation of the diagnosed growth. The possible treatments and prognosis for these growths are briefly described. less
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Tumors of the Urogenital Tract
Neoplasia has been reported to involve the majority of the urinary system of the horse, with tumors affecting the kidneys and bladder most comprehensively described. Primary tumors of the external genitalia are relatively common in the horse and are easil... moreNeoplasia has been reported to involve the majority of the urinary system of the horse, with tumors affecting the kidneys and bladder most comprehensively described. Primary tumors of the external genitalia are relatively common in the horse and are easily identified on clinical examination while primary tumors of the upper urogenital tract are uncommon. This article will highlight the common tumors, their clinical presentations, and discuss potential medical and surgical treatment options available. The less common neoplasms will be mentioned but not discussed in depth. less
