Multiple Meningioma Resection by Bilateral Extended Rostrotentorial Craniotomy with a 3D-Print Guide in a Cat

Abstract

A 13-year-old castrated male domestic shorthair cat was referred for the surgical removal of multiple meningiomas. The cat experienced generalized tonic–clonic seizures, altered mentation, mild proprioceptive ataxia, and circling. Magnetic resonance imaging (MRI) revealed two round, solitary, well-delineated, space-occupying lesions suggestive of multiple meningiomas in the right frontal and occipital lobes. Before surgery, patient-specific three-dimensional (3D) printed models and guides were produced using a 3D program based on MRI and computed tomography (CT), and a rehearsal surgery was performed. With a 3D guide to find the location of the craniotomy lines, bilateral extended rostrotentorial craniotomy allowed en bloc resection of multiple meningiomas. The bone fragment was replaced and secured to the skull with a craniofacial plate and screws with an artificial dura. All of the surgical steps were performed without complications. The preoperative presenting signs were resolved by the time of follow-up examinations 2 weeks after surgery. Twelve months after the removal of the multiple meningiomas, the cat survived without further neurological progression. For the resection of multiple meningiomas, surgery can result in large bone defects and risk of massive hemorrhage. For this challenging surgery, patient-specific 3D models and guides can be effective for accurate and safe craniotomies.

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

“…Complex surgical approaches are more invasive, longer and harder to perform but may be required to remove large or invasive tumors. With the recent development of 3D preoperative planning, patient specific models and cutting guides, those complex approaches may become safer to perform [ 9 ]. Moreover, the use of neuronavigation may also reduce perioperative complications, but this was not available at our institution [ 34 ].…”

“…Meningioma affects adult cats (3–21 years) [ 1 4 5 6 ], and the median age at diagnosis is 11–12 years [ 2 4 7 ]. In cats, meningiomas are mostly solitary, but multiple meningiomas are not infrequent and may represent up to 17% of cases [ 1 8 9 ]. As feline meningioma is frequently located peripherally and is mostly non-invasive and benign (World Health Organization grade I), unlike canine meningiomas [ 1 3 5 ], surgical resection, when feasible, is often the treatment of choice.…”

Use of Computed Tomography and Magnetic Resonance Angiograms Combined with a 3D Surgical Guide in an Elderly Cat with an Occipital Lobe Meningioma

“…The cerebral arteries and veins were manually segmented using the original and post-processed datasets. The virtual reconstruction of the brain was performed using an image-processing program (MeVisLab; Fraunhofer Mevis, Bremen, Germany) (Figure 3) [27].…”

“…The cerebral arteries and veins were manually segmented using the original and post-processed datasets. The virtual reconstruction of the brain was performed using an image-processing program (MeVisLab; Fraunhofer Mevis, Bremen, Germany) (Figure 3) [27]. Bone data were obtained from the CT images and sliced into an STL file using 3D slicer software (3D Slicer, [www.slicer.org] accessed on 24 November 2021).…”

“…In addition, a virtual 3D surgical guide was designed using 3D modeling software (3DS MAX; Autodesk, Inc., San Rafael, CA, USA) to cover the bony surface of the window for the exact location during the operation (Figure 4). The virtual guide was transferred to an STL file and printed using an FDM-type 3D printer and a PLA filament [27]. Bone data were obtained from the CT images and sliced into an STL file using 3D slicer software (3D Slicer, [www.slicer.org] accessed on 24 November 2021).…”