Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation

Abstract

OBJECTIVE To describe the use of a customized 3–D-printed titanium prosthesis as adjunctive treatment for foramen magnum decompression (FMD) in dogs with Chiari-like malformation (CM) and syringomyelia (SM). ANIMALS 8 dogs with clinical signs and MRI findings of CM-SM. PROCEDURES 3-D reconstruction of CT images of the head was used to simulate an occipital craniectomy and design the prosthesis. FMD was performed, and the prosthesis was implanted. Follow-up was performed 1, 6, and 12 months later, and clinical status was scored. Repeated MRI images were compared to identify changes involving the neural structures, particularly the syrinx. RESULTS All prostheses were easily positioned based on the preoperative 3-D models, with no complications. At 12 months after surgery, 3 dogs were free of previous medications, 4 were still receiving steroid medications but at lower doses, and 1 was occasionally receiving acupuncture. MRI of 5 dogs 6 to 20 months after surgery revealed resolution of SM (n = 1), reduced size of SM (3), or worse SM (1). All dogs showed an increase in size of the caudal cranial fossa. Dogs with a longer presurgical duration of the clinical signs and wider syrinx generally had worse outcomes than other dogs. CLINICAL RELEVANCE Findings suggested that use of customized 3–D-printed titanium prosthesis and associated FMD can represent an adjunctive option to medically treated dogs with CM-SM. Although the small number of cases precludes definitive conclusions, early surgical treatment, particularly in dogs with a small syrinx, could ensure better long-term outcomes, as previously suggested.

Biopsy and histologic findings of the dura mater at the level of the foramen magnum in 121 CKCS with Chiari-like malformation

“…No cervical instability was noted; therefore, no additional stabilization was necessary. The lateral limits of the boney decompression were the lateral foramina of the C1 and each atlanto-occipital joint ( 42 , 43 ). A full thickness durectomy was performed along the aforementioned borders of the boney decompression using a blunt hook nerve root retractor and number 11 blade.…”

Dermatological Problems of Brachycephalic Dogs

“…For severe cases or dogs not responding to medical treatment, there is up to an 80% chance of clinical improvement following foramen magnum decompression and durotomy [ 43 , 133 ]. Duraplasty or craniotomy/cranioplasty in combination with tissue grafting/titanium prosthesis/titanium mesh/polymethylmethacrylate plate further improves the success rate [ 129 , 134 ]. However, despite surgical intervention, residual scratching is often reported [ 129 , 135 ].…”

World experience in use of three-dimensional titanium implants in veterinary practice

“…James с соавторами описали три случая восстановления дефектов черепа у собак после резекций опухолей титановой сеткой, изготовленной на 3D-принтере по индивидуальным проектам [17]. Успешные результаты были получены при затылочной краниопластике с использованием индивидуальных титановых протезов в сочетании с декомпрессией большого затылочного отверстия у 8 собак, страдающих мальформацией [18]. При реконструкции дефектов критического размера, деформирующего контуры нижней челюсти с использованием титановых матриц, нагруженных человеческим рекомбинантным морфогенетическим белком (rhBMP-2) собаки вернулись к обычному образу жизни [19].…”