Diagnosis, treatment and postsurgical complications in a dog with epileptic seizures and a naso-ethmoidal meningoencephalocele

Abstract

Background Naso-ethmoidal meningoencephalocele is usually a congenital anomaly consisting of a protrusion of cerebral tissue and meninges into the ethmoidal labyrinth. The condition is a rare cause of structural epilepsy in dogs. We report the clinical presentation, surgical intervention, postoperative complications and outcome in a dog with drug resistant epilepsy secondary to a meningoencephalocele. Case presentation A 3.3-year-old male neutered Tamaskan Dog was referred for assessment of epileptic seizures secondary to a previously diagnosed left-sided naso-ethmoidal meningoencephalocele. The dog was drug resistant to medical management with phenobarbital, potassium bromide and levetiracetam. Surgical intervention was performed by a transfrontal craniotomy with resection of the meningoencephalocele and closure of the dural defect. Twenty-four hours after surgery the dog demonstrated progressive cervical hyperaesthesia caused by tension pneumocephalus and pneumorrhachis. Replacement of the fascial graft resulted in immediate resolution of the dog’s neurological signs. Within 5 months after surgery the dog progressively developed sneezing and haemorrhagic nasal discharge, caused by sinonasal aspergillosis. Systemic medical management with oral itraconazole (7 mg/kg orally q12h) was well-tolerated and resulted in resolution of the clinical signs. The itraconazole was tapered with no relapsing upper airway signs. The dog’s frequency of epileptic seizures was not affected by surgical resection of the meningoencephalocele. No treatment adjustments of the anti-epileptic medication have been necessary during the follow-up period of 15 months. Conclusions Surgical resection of the meningoencephalocele did not affect the seizure frequency of the dog. Further research on prognostic factors associated with surgical treatment of meningoencephaloceles in dogs is necessary. Careful monitoring for postsurgical complications allows prompt initiation of appropriate treatment.

Polysulfone tailor-made implant for the surgical correction of a frontoparietal meningoencephalocoele in a cat

“…Although MEC/MCs have been described in dogs and cats, 1 – 12 and also occasionally reported in other species, including calves, 14 – 18 pigs, 19 a rabbit 20 and a raccoon, 21 most of those animals were euthanased or treated conservatively. Medical management has been suggested for 22 dogs with MC/MEC and mild neurological signs.…”

“… 2 However, 73% of those dogs suffered an intranasal MEC and only 27% had the parietal bone affected; all of them with only meninges protruding through the parietal bone defect. 2 On the other hand, surgical correction has only been described in two dogs, 8 , 10 two cats 1 , 11 and two calves. 15 , 17 The scarce number of MEC cases described in the veterinary literature precludes any conclusion regarding the best treatment option for this pathology, and needs to be evaluated on a case-by-case basis.…”

“…Meningocoele (MC)/MEC is a relatively uncommon disease reported in companion animals, 1 – 12 and only four cases of surgical correction have been described. 1 , 8 , 10 , 11 Although a multicentric retrospective study involving 22 dogs suggested that medical management could be an option for dogs with MC/MEC and mild neurological signs, 2 surgical intervention is considered the treatment of choice in human medicine. 13 …”

Case Report: Detection of Transferrin in a Dog Suspected of Having Cerebrospinal Fluid Rhinorrhea

“…Other techniques include multiple closure using fat, fascia, cartilage, artificial dura mater, and nasal mucosa, and a closure technique using a stalked mucosal valve that takes nutritional blood vessels into account (16). In small animal medicine, some meningoencephalocele cases showed CSF rhinorrhea, and there are sporadically reports describing surgical repair of meningoencephaloceles (28)(29)(30). Further studies are needed to clarify what surgical option is best and under what conditions it should be performed.…”

“…Serum and CSF from a healthy dog (Beagle, 1 year old, female) were used as controls. This procedure was conducted with the approval of Osaka Prefecture University Animal Care and Use Committee (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The sample was loaded on 1-mm thick sodium dodecyl sulfate polyacrylamide gels and was separated by electrophoresis.…”