Intracranial abscess caused byRhodococcus equiinfection in a foal

A transmandibular lateral transsphenoidal navigated surgical approach to access a pituitary macroadenoma in a warmblood mare

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.

Occipital condyle defects assessed by radiography or CT can be a normal finding in foals

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.

Development of two surgical approaches to the pituitary gland in the Horse

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.

Arthroscopic approach and intra-articular anatomy of the equine atlanto-occipital joint

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.

Rhodococcus equi: the many facets of a pathogenic actinomycete

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.

Magnetic Resonance Imaging of Bacterial Meningoencephalitis in a Foal

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.

Computed tomography-guided brain biopsy for in vivo diagnosis of a cholesterinic granuloma in a horse

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.

Preliminary anatomic investigation of three approaches to the equine cranium and brain for limited craniectomy procedures

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.