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Case study: A Bilateral transtentorial craniotomy in a 12 year old cat

7th July 2021

Do we miss opportunities to positively impact the quality of life in older patients because we don’t consider them to be surgical candidates?  With advances in anaesthesia and surgical developments, should we be more inclined to operate on older patients?

Will.i.am is a 12-year-old male neutered domestic short hair cat who presented to our neurology service following an acute onset of behavioural changes (pacing, episodes of anorexia, poorly responsive to interaction with the owner).

Presentation

On clinical examination, he was pacing around the consult room with a dull demeanour, was poorly responsive to visual and auditory stimuli, and had a mild hemi-walking postural reaction deficit on his left-hand side. His examination localised his problem to a lesion affecting the bilateral forebrain.

Diagnostics

An MRI confirmed that he had a space-occupying mass lesion that, based on appearance, was most likely consistent with a meningioma (tumour originating from the meninges) expanding within the skull and compressing the brain.

Figure 1: MRI images of the space occupying lesion, suspected to me a meningioma

Prognosis

The prognosis for surgery with meningioma in cats is relatively good, as a large proportion of meningiomas in cats are considered to be relatively benign (grade 1). There is a perioperative mortality of approximately 20% in cats.

Procedure

Will.i.am had a bilateral transtentorial craniotomy performed by our neurologists, George and Nicolas, to remove the mass. A small section of skull was removed and the tumour was gently separated from the normal brain tissue to relieve the intracranial pressure. Unfortunately there were some areas (near the great cerebral vein) where it was not possible to safely remove parts of the tumour, so we cannot be sure that all the tumour was removed.

Follow up and results

Following a few days of hospitalisation and TLC with his owner, Will.i.am was back to his normal self, eating and drinking and jumping around. The tumour was sent for histopathological assessment and came back as a grade 1 meningioma. So it is likely that Will.i.am will continue to have an excellent quality of life for the foreseeable future. Here he is 2 weeks after surgery, wanting to escape the consult room and go outdoors again!

Progress update: Will.i.am is doing very well at home and is back to keeping the household awake at night playing with his toys.

William the cat

Figure 2: Will.i.am the cat
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