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de Preux M, Precht C, Guevar J, Graubner C, Thenhaus-Schnabel S, Buser L, Lukes A, Koch C. A transmandibular lateral transsphenoidal navigated surgical approach to access a pituitary macroadenoma in a warmblood mare. Vet Q 2024; 44:1-10. [PMID: 38393300 PMCID: PMC10896130 DOI: 10.1080/01652176.2023.2300947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/26/2023] [Indexed: 02/25/2024] Open
Abstract
A 16-year-old warmblood mare was referred with a progressive history of behavioral changes and left-sided blindness. Following neuroanatomical localization to the forebrain, magnetic resonance imaging of the head revealed a well-delineated, 4.5 cm in diameter, round pituitary mass causing marked compression of the midbrain and optic chiasm. Euthanasia was recommended but declined by the owners. Veterinary specialists and a human neurosurgeon collaboratively prepared for surgical case management. A novel navigated transmandibular lateral transsphenoidal approach was developed to access the region of the sella turcica and practiced on cadaver specimens. The horse was anesthetized and placed in sternal recumbency with the head above the heart line. Using a cone beam computed tomography (CBCT)-coupled navigation system, a navigated pin traversing the vertical ramus of the mandible and the lateral pterygoid muscle was placed in a direct trajectory to the predetermined osteotomy site of the basisphenoid bone. A safe corridor to the osteotomy site was established using sequential tubular dilators bypassing the guttural pouch, internal and external carotid arteries. Despite the use of microsurgical techniques, visualization of critical structures was limited by the long and narrow working channel. Whilst partial resection of the mass was achieved, iatrogenic trauma to the normal brain parenchyma was identified by intraoperative imaging. With consent of the owner the mare was euthanized under the same general anesthesia. Post-mortem magnetic resonance imaging and gross anatomical examination confirmed partial removal of a pituitary adenoma, but also iatrogenic damage to the surrounding brain parenchyma, including the thalamus.
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Affiliation(s)
- Mathieu de Preux
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Christina Precht
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Department of Surgery, Small Animal Clinic, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Claudia Graubner
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Sebastian Thenhaus-Schnabel
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Larissa Buser
- Division of Anaesthesiology and Pain Management, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Anton Lukes
- Department of Neurosurgery, Lindenhof Hospital, Bern, Switzerland
| | - Christoph Koch
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
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Sage SE, Olive J, Lavoie JP. Occipital condyle defects assessed by radiography or CT can be a normal finding in foals. Vet Radiol Ultrasound 2020; 62:218-224. [PMID: 33315284 DOI: 10.1111/vru.12940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022] Open
Abstract
Age of complete ossification of equine occipital condyles has not been published. Consequently, clinical significance of occipital condyle defects on radiographs or CT scans of young horses remains unknown. The goals of this single-center, retrospective, cross-sectional study were to characterize incidental occipital condyle defects and to define the age of complete ossification. The margin of occipital condyles was classified as regular or with defect(s). Analyses were made on 121 horses, including 106 radiographic and 19 CT studies showing the occipital condyles of horses less than 5 years of age obtained over 6 years in a referral hospital. Neurological signs and outcome were not associated with occipital defects. Horses with regular occipital condyles on radiographs had a median age of 974 days (median interquartile range = 707) compared with 47 days (interquartile range = 106) in the defect group. The odds of finding radiographically regular occipital condyles were 2.6% higher for each additional day of age (P = .011, 95% CI, 0.6-4.7%). In the CT group, univariate analyses demonstrated a significant effect of age on the aspect of occipital condyles (P = .016). Horses with regular occipital condyles were older (median age = 881 days; interquartile range = 1054) than horses with a defect (median age = 109 days, interquartile range = 318). All horses above 156 days (5.1 months) of age and 550 days (18.1 months) of age had regular occipital condyles on radiographic and CT images, respectively. This study describes occipital condyle defects as a potential normal finding in young horses and provides guidelines for interpretation of the occipital condyle ossification process.
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Affiliation(s)
- Sophie Elena Sage
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Julien Olive
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada.,Vet-CT Specialists, Cambridge, UK
| | - Jean-Pierre Lavoie
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
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Schott HC, Esser MM, Pirie CG, Pease AP, Patterson JS, Reed SM. Long‐term successful outcome of a
Streptococcus equi
subspecies
equi
brain abscess. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H. C. Schott
- Department of Large Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - M. M. Esser
- Department of Large Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - C. G. Pirie
- Department of Small Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - A. P. Pease
- Department of Small Animal Clinical Sciences College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - J. S. Patterson
- Veterinary Diagnostic Laboratory College of Veterinary Medicine Michigan State University East Lansing Michigan USA
| | - S. M. Reed
- Rood and Riddle Equine Hospital Lexington Lexington Kentucky USA
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Carmalt JL, Scansen BA. Development of two surgical approaches to the pituitary gland in the Horse. Vet Q 2018; 38:21-27. [PMID: 29219746 PMCID: PMC6831024 DOI: 10.1080/01652176.2017.1415488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/06/2017] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Current treatment of equine pituitary pars intermedia dysfunction (PPID) requires daily oral medication. Minimally invasive surgical palliation of this condition is appealing as a single treatment to alleviate the clinical signs of disease, dramatically improving the welfare of the horse. OBJECTIVE To develop a surgical approach to the equine pituitary gland, for subsequent treatment of PPID. STUDY DESIGN A cadaver study to develop methodology and a terminal procedure under anaesthesia in the most promising techniques. ANIMALS AND METHODS Four surgical approaches to the pituitary gland were investigated in cadaver animals. A ventral trans-basispheniodal osteotomy and a minimally invasive intravenous approach via the ventral cavernous sinus progressed to live horse trials. RESULTS Technical complications prevented the myeloscopic and trans-sphenopalatine sinus techniques from being successful. The ventral basisphenoidal osteotomy was repeatable and has potential if an intra-operative imaging guidance system could be employed. The minimally invasive approach was repeatable, atraumatic and relatively inexpensive. CONCLUSIONS A minimally invasive surgical approach to the equine pituitary gland is possible and allows for needle placement within the target tissue. More work is necessary to determine what that treatment might be, but repeatable access to the gland has been obtained, which is a promising step.
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Affiliation(s)
- James L. Carmalt
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Brian A. Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Broux B, van Bergen T, Schauvliege S, Vali Y, Lefère L, Gielen I. Successful surgical debridement of a cerebral
Streptococcus equi equi
abscess by parietal bone flap craniotomy in a 2‐month‐old Warmblood foal. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- B. Broux
- Department of Large Animal Internal Medicine Ghent University Merelbeke Belgium
- Clinique Equine d'Acy‐Romance Acy‐Romance France
| | - T. van Bergen
- Clinique Equine d'Acy‐Romance Acy‐Romance France
- Department of Surgery and Anaesthesiology Ghent University Merelbeke Belgium
| | - S. Schauvliege
- Department of Surgery and Anaesthesiology Ghent University Merelbeke Belgium
| | - Y. Vali
- Department of Radiology and Surgery Faculty of Veterinary Medicine University of Tehran Tehran Iran
| | - L. Lefère
- Department of Large Animal Internal Medicine Ghent University Merelbeke Belgium
| | - I. Gielen
- Department of Medical Imaging and Small Animal Orthopaedics Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
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Wright L, Puchalski SM, Kristoffersen M, Lindegaard C. Arthroscopic approach and intra-articular anatomy of the equine atlanto-occipital joint. Vet Surg 2018; 47:756-767. [PMID: 30004116 DOI: 10.1111/vsu.12932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/12/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop arthroscopic approaches to the atlanto-occipital (A-O) and describe associated arthroscopic anatomy. STUDY DESIGN Experimental ex vivo study and clinical case report. ANIMALS Ten equine cadaver joints and 1 clinical case. METHODS CT arthrograms of 8 A-O joints were performed to determine the placement of an arthroscopic portal. Arthroscopy was performed via dorsal and/or ventral approaches (dorsal or ventral to the longissimus capitis tendon) in 10 cadaveric A-O joints and the A-O joint of a 2-week-old foal with septic arthritis. Accessible cartilage was debrided in 3 cadaver joints. Accessibility and risks were assessed by review of arthroscopic images, postoperative necropsy, and computed tomography (CT). RESULTS Dorsal and ventral outpouchings of the A-O joint were identified with CT. Arthroscopy of the dorsal pouch provided access to 50% of the dorsocranial occipital condyle and 15% of the dorsocranial atlas articular surfaces. Joint distension caused displacement of the dura. Dura perforation occurred with a blind dorsal approach in 2 of 5 joints. Dura perforation did not occur after ultrasonography-guided approaches. Arthroscopic debridement of septic arthritis and osteomyelitis was successful in 1 clinical case. CONCLUSION Approaches to the A-O joint were determined from CT examinations. The cranial aspect of the dorsal pouch of the A-O joint was accessed via arthroscopic triangulation in all horses of this study. Ultrasound-guided joint access prevented perforation of vital structures, including the spinal canal. CLINICAL SIGNIFICANCE Advanced imaging improves the diagnosis of A-O joint pathology. Descriptions of arthroscopic anatomy and accessibility provide important information for surgical intervention.
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Affiliation(s)
- Linda Wright
- Evidensia Equine Hospital Helsingborg, Helsingborg, Sweden
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Affiliation(s)
- S. M. Reuss
- Department of Large Animal Clinical Sciences; University of Florida College of Veterinary Medicine; Gainesville USA
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Vázquez-Boland JA, Giguère S, Hapeshi A, MacArthur I, Anastasi E, Valero-Rello A. Rhodococcus equi: the many facets of a pathogenic actinomycete. Vet Microbiol 2013; 167:9-33. [PMID: 23993705 DOI: 10.1016/j.vetmic.2013.06.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 12/20/2022]
Abstract
Rhodococcus equi is a soil-dwelling pathogenic actinomycete that causes pulmonary and extrapulmonary pyogranulomatous infections in a variety of animal species and people. Young foals are particularly susceptible and develop a life-threatening pneumonic disease that is endemic at many horse-breeding farms worldwide. R. equi is a facultative intracellular parasite of macrophages that replicates within a modified phagocytic vacuole. Its pathogenicity depends on a virulence plasmid that promotes intracellular survival by preventing phagosome-lysosome fusion. Species-specific tropism of R. equi for horses, pigs and cattle appears to be determined by host-adapted virulence plasmid types. Molecular epidemiological studies of these plasmids suggest that human R. equi infection is zoonotic. Analysis of the recently determined R. equi genome sequence has identified additional virulence determinants on the bacterial chromosome. This review summarizes our current understanding of the clinical aspects, biology, pathogenesis and immunity of this fascinating microbe with plasmid-governed infectivity.
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Affiliation(s)
- José A Vázquez-Boland
- Microbial Pathogenesis Unit, School of Biomedical Sciences and Edinburgh Infectious Diseases, University of Edinburgh, Edinburgh EH9 3JT, UK; Grupo de Patogenómica Bacteriana, Facultad de Veterinaria, Universidad de León, 24071 León, Spain.
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Kelmer G, Martin-Jimenez T, Saxton AM, Catasus C, Elliot SB, Lakritz J. Evaluation of regional limb perfusion with erythromycin using the saphenous, cephalic, or palmar digital veins in standing horses. J Vet Pharmacol Ther 2012; 36:434-40. [DOI: 10.1111/jvp.12028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 11/02/2012] [Indexed: 11/26/2022]
Affiliation(s)
- G. Kelmer
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - T. Martin-Jimenez
- Comparative Medicine; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - A. M. Saxton
- Department of Animal Science; College of Agricultural Sciences and Natural Resources; University of Tennessee; Knoxville TN USA
| | - C. Catasus
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - S. B. Elliot
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - J. Lakritz
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus OH USA
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Barba M, Lepage OM. Diagnostic utility of computed tomography imaging in foals: 10 cases (2008-2010). EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2012.00422.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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VIU J, MONREAL L, JOSE-CUNILLERAS E, CESARINI C, AÑOR S, ARMENGOU L. Clinical findings in 10 foals with bacterial meningoencephalitis. Equine Vet J 2012:100-4. [DOI: 10.1111/j.2042-3306.2011.00508.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Magnetic resonance imaging (MRI) in equidae suffering meningoencephalitis (ME) has not been described. The objective of this paper is to describe brain MRI findings in a foal with bacterial ME. A five-month-old, 200 kg bwt Arabian filly was referred with a history of abnormal mental status and locomotion. The filly was recumbent and obtunded, and pupillary light reflexes were sluggish, and oculocephalic movements were normally present. Ophthalmic examination revealed bilateral optic neuritis. Hematology revealed leukocytosis and neutrophilia. Cerebrospinal fluid analysis showed neutrophilic pleocytosis with intracellular bacteria. On brain MRI, there were multifocal cortical areas of mild hyperintensity on T2-weighted images (T2WI) affecting both hemispheres. The lesions had ill-delineated margins, and there was loss of differentiation between gray and white matter. Diffuse hyperintensity was also identified in the left cerebellar cortex on T2WI. Neither mass effect nor cerebral midline shift were identified. On FLAIR images, the lesions were also hyperintense and, in some areas, they seemed to coalescence to form diffuse cortical areas of hyperintensity. The MRI findings described were similar to the MRI features described in cases of humans and small animals with ME. Brain MRI can be a useful diagnostic tool in foals and small-sized equidae with intracranial disease.
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Giguère S, Cohen N, Keith Chaffin M, Hines S, Hondalus M, Prescott J, Slovis N. Rhodococcus equi: Clinical Manifestations, Virulence, and Immunity. J Vet Intern Med 2011; 25:1221-30. [DOI: 10.1111/j.1939-1676.2011.00804.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/01/2011] [Accepted: 08/15/2011] [Indexed: 11/27/2022] Open
Affiliation(s)
- S. Giguère
- Department of Large Animal Medicine; University of Georgia; Athens; GA
| | - N.D. Cohen
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Texas A&M University; College Station; TX
| | - M. Keith Chaffin
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Texas A&M University; College Station; TX
| | - S.A. Hines
- Department of Veterinary Microbiology and Pathology; Washington State University; Pullman; WA
| | - M.K. Hondalus
- Department of Infectious Diseases; University of Georgia; Athens; GA
| | - J.F. Prescott
- Department of Pathobiology; University of Guelph; Guelph; ON; Canada
| | - N.M. Slovis
- Hagyard Equine Medical Institute; Lexington; KY
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Morresey PR, Garrett KS, Carter D. Rhodococcus equi occipital bone osteomyelitis, septic arthritis and meningitis in a neurological foal. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00119.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reuss SM, Chaffin MK, Cohen ND. Extrapulmonary disorders associated withRhodococcus equiinfection in foals: 150 cases (1987–2007). J Am Vet Med Assoc 2009; 235:855-63. [DOI: 10.2460/javma.235.7.855] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vanschandevijl K, Gielen I, Nollet H, Vlaminck L, Deprez P, van Bree H. Computed tomography-guided brain biopsy for in vivo diagnosis of a cholesterinic granuloma in a horse. J Am Vet Med Assoc 2008; 233:950-4. [PMID: 18795858 DOI: 10.2460/javma.233.6.950] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-year-old warmblood mare was evaluated following an acute onset of neurologic abnormalities. CLINICAL FINDINGS Computed tomography of the head revealed large masses in both lateral ventricles, and a presumptive diagnosis of cholesterinic granuloma was made. TREATMENT AND OUTCOME Freehand biopsy of the intracranial masses was performed under computed tomographic guidance, and histologic examination of biopsy specimens confirmed the diagnosis. No adverse effects associated with the brain biopsy procedure were encountered. Clinical signs resolved, and long-term follow-up did not reveal any recurrence of neurologic deficits. The horse was able to return to its previous level of training. CLINICAL RELEVANCE Findings suggested that computed tomographic-guided brain biopsy is feasible in horses and can be used to establish a diagnosis in horses with intracranial masses.
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Affiliation(s)
- Katleen Vanschandevijl
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
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Exophthalmos Caused by Chronic Sinusitis in a Horse: A Case of Exophthalmos Caused by Sinusitis. J Equine Vet Sci 2007. [DOI: 10.1016/j.jevs.2007.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kramer J, Coates JR, Hoffman AG, Frappier BL. Preliminary anatomic investigation of three approaches to the equine cranium and brain for limited craniectomy procedures. Vet Surg 2007; 36:500-8. [PMID: 17614932 DOI: 10.1111/j.1532-950x.2007.00297.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe surgical approaches to the equine cranium and brain for limited craniectomy. STUDY DESIGN Descriptive anatomic study. SAMPLE POPULATION Equine cadavers (n=7). METHODS Head and neck sections from cadavers were used to establish techniques for exposing areas of the equine brain. Three basic approaches were used: rostrotentorial, suboccipital, and transfrontal. Techniques were adapted from small animal descriptions and modified to account for anatomic differences. RESULTS Descriptions of the rostrotentorial, suboccipital, and transfrontal approaches to the equine cranium and brain were defined. CONCLUSIONS Dorsal, caudal, lateral, and rostral aspects of the cranium and underlying cerebral cortex can be accessed using the rostrotentorial, suboccipital, and transfrontal approaches. Access to the dorsal, dorsolateral, and rostral aspects of the cerebral cortex is uncomplicated and more superficial compared with access to the extreme caudolateral cerebrum and cerebellum, which is complicated by the location of the transverse and temporal sinuses and deep exposure. CLINICAL RELEVANCE Many cases of equine brain disorders involve intracranial abscessation or hematoma formation because of trauma. Components of therapy may include microbial culture and surgical drainage or decompression of the affected area through limited craniectomy procedures. Increased use of advanced imaging in equine brain disease has resulted in earlier diagnosis and more precise lesion localization. Subsequently, the number of horses likely to improve with limited surgical intervention has increased. When surgery is indicated, descriptions of surgical approaches to the equine cranium and brain provide important information.
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Affiliation(s)
- Joanne Kramer
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, MO, USA.
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