Prepare for unexpected vet bills
When something causes the brain to swell, if it is not alleviated, increased intracranial pressure (often called ICP) can be catastrophic. Severe head trauma or large tumor growth can lead to heightened ICP levels. When this occurs, a procedure called a “decompressive craniectomy” may be performed in an attempt to protect the brain and relieve pressure. This must be done quickly, or else the damage done may be irreversible.
A decompressive craniectomy often consists of two surgical procedures. In the first surgery, a portion of the skull is removed to that pressure can be released. This is often performed on an emergency basis. A second surgery is needed to reconstruct the hole in the skull and may be performed up to one year after the first procedure. New techniques may allow this all to be done simultaneously in one operation by use of a permanent metal hinge. This surgery should only be completed by an ACVS board-certified veterinary surgeon.
If the setting allows it, the dog's blood will be tested to assess whether it is likely to survive the use of general anesthesia. A CT scan will be used to locate any damage or tumors in the brain. This helps the surgeon plan where to remove a portion of the skull, as a decompressive craniectomy can be paired with tumor biopsy or removal. The dog will be given an IV, and then pain relief drugs followed by anesthesia will be administered. The dog's head will be clipped and cleaned in preparation for the surgery.
As the operation begins, the dog's heart rate and blood pressure will need to be checked every five minutes to ensure the animal is stable. The head can then be incised, exposing the skull. A portion of the skull will then be cut out and removed. This piece of bone can be preserved and reused in the reconstructive surgery or disposed of if biomaterials are going to be used instead. If a metal implant is going to be used, it will be attached the the removed piece of skull. If a tumor is present, it will be excised or biopsied at this point. If the hole that has been made is small enough, the temporalis muscle can be pulled over it, eliminating the need for further surgery. The skin on the head can then be closed using sutures or staples.
This is a complicated and risky procedure that can effectively reduce life-threatening pressure in the brain. Any neurological damage that has occurred will likely be permanent. The majority of healing will take place in the first seven days. The earlier that a reconstructive cranioplasty can be performed, the better the outcome for the dog as this reduces the chance of hydrocephalus and epilepsy. If the dog has been diagnosed with cancer, the overall prognosis is guarded and will depend on the type of cancer present and how aggressive it is.
After surgery, the dog's ICP must be continuously monitored for at least six hours. It will be checked twice daily for the remainder of the dog's hospital stay. The dog will be prescribed a course of antibiotics to protect the brain from infection. The dog's activity will need to be restricted for some time after it has been discharged. A helmet will be given to be used whenever the dog is outdoors.
A follow-up appointment will be needed to assess how the incision is healing and to measure the dog's intracranial pressure. At this point the surgeon will determine if a second surgery is necessary and when it should be carried out. If a biopsy was collected, the results will be examined and a course of treatment may be started.
Decompressive craniectomies are very complex procedures that are often paired with other high-risk surgeries. A specialist may be needed for the following cranioplasty to reconstruct the removed portion of the skull. Advanced imaging is necessary to carry out the surgery. If the dog has been diagnosed with cancer, a craniectomy along with chemotherapy or radiation therapy will be needed. The cost for this procedure can range from $5,000 all the way up to $25,000. There is generally no alternative other than euthanasia.
All surgery that involves the use of general anesthesia brings rare but serious risks. When the skull is opened, there is a chance that the cranial vault can become infected, which leads to further potentially life-threatening complications. The larger the hole that is created in the skull, the higher the risk of infection is. If the dog has cancer, the overall prognosis should be considered, as the surgery may only extend the dog's life by a few extra months.
The chance of severe head trauma can be decreased by keeping your dog on leash at all times during walks. Secure your backyard to ensure there are no spaces that your dog can exit from. Do not rely solely on invisible fences. Many cancers are hereditary, so always ask for your dog's family health history when obtaining the animal. Do not expose your dog to known cancer-causing agents such as cigarette smoke or car exhaust.
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