SURGERY


The surgical section operating at La Cittadina Fondazione Studi e Ricerche Veterinarie is active in the field of neurosurgery and oncology. Are performed spinal and cranial neurosurgery and surgical oncology operations within the appendiceal (for example limb salvage surgery for appendicular osteosarcoma), surgery for soft tissue sarcoma, surgery of the head and neck tumors, pelvic, perineal and genital area surgery. The operating room is equipped with apparatus Dräger Zeus Infinity Empowered anesthesia system, Zeiss NC-4 Microscope, Intensifier GE Stenoscop. In spinal neurosurgery minimally invasive interventions are preferred. The availability of the operating microscope allows access to the anatomical structures through very small breaches. In this way we obtain a higher precision in surgical procedure with reduced mobility and significantly shortened functional recovery time.    

At vertebral level great attention is paid to surgery stabilization. Also in this area is privileged mini-invasive access with particular use of open surgery methods. To this end, a recent area of activation is that of interventional radiology. This provides through fluoroscopic control performing surgeries usually require open surgery approach (urologic application of ureteral stents, osteosynthesis performed by closed surgery with external or internal fixation through plaques or blocked nails). Relatively to the urinary tract, the Centre has always cultivated an interest in more suitable therapies to the correction of benign and malignant disease of the urinary tract, with particular attention to the congenital malformations (ectopic ureter and ureterocele) as well as to the traumatic urethral pathologies (laceration and avulsion of the urethra, urethral stricture).

Surgical interventions:

 ✩ LIMB SALVAGE SURGERY AFFECTED BY BONE CANCER

Blues was suffering from a distal radial osteosarcoma. This type of cancer is well suited to the limb salvage surgery, since it is widely demonstrated in the course of the appendicular osteosarcoma amputation not only significantly increases the median survival. The limb salvage surgery can be an alternative to amputation, especially in patients who are particularly heavy and exuberant. Obviously salvage surgery is adapted to improve the quality of life of the patient by ensuring the use of the limb and allowing a good control of locoregional tumor. However, in order to control any distant metastases the therapeutic adjuvants are needed, such as post-operative chemotherapy or in case neoadjuvant. Blues was subjected to radial distal osteotomy 15 days after the first cycle of chemotherapy with carboplatin, pasteurization of the piece involved by the tumor, repositioning the workpiece after pasteurization, sympathized through a specific plaque stuck developed by us. Regarding the staging and the balance of the extension of the neoplastic disease, Blues was subjected beforehand to total CT and MRI of the limb in order to well establish the margins of the lesion and to assess the presence of any distant metastases. 3 years after surgery Blues feels good, uses the limb for walking and running and is gradually removing the fixation with the ultimate goal of removing the system completely.

 ✩ URETERAL STENT

Dilatazione della stenosi mediante palloncino

As a result of urethral trauma in dogs and cats may occur acute damages variable from contusion to laceration, possibly with bladder avulsion. Independently from the primary lesion and treatment options, including secondary damage it includes the post-traumatic urethral stricture. The use of ureteral stents positioned by fluoroscopy fulfills the need to treat this type of injury. 

In the case of Dante we describe a patient who, following a penetrating trauma penetrante occorso in regione perineale che aveva determinato una lacerazione parziale dell'uretra, aveva poi sviluppato una stenosi del tratto in oggetto. Dante è stato trattato mediante applicazione stent uretrale in lega termoespansibile sganciato sotto controllo fluoroscopico previa dilatazione assiale del tratto stenotico con palloncino. The patient after one year maintains a good capability of urination and demonstrate no signs related to recurrence or urinary incontinence.

MENINGIOMA

The therapy of meningioma is essentially surgical. Since this tumor that originates from the meninges causing a compression on the neural surrounding tissue, the surgical act is essentially decompressive, volto cioè ad asportare nella sua interezza la massa con particolare riguardo alla base d'impianto durale o lepto-meningea. 

Regarding the intracranial meningiomas, surgical onsets provide a craniotomy that can be performed with various types of tools. As an alternative to surgical removal procedure, especially if the meningioma is localized at sites of complex access such as the skull base, the radiosurgery can be used. In this last case without proceeding to any surgery access, radiation treatment is planned by delivering a preset dose of X-rays (photons) to the tumor volume with a very sharp dose gradient between tumor tissue and healthy tissue around it. In case of surgical treatment of meningioma is necessary that the patient is adequately stabilized before therapy, resorting to anti-edema and anti-inflammatory drugs, such as corticosteroids, diuretics, and anticonvulsants. The anesthetic management of patients undergoing craniotomy is particularly delicate from the moment when various vital parameters must be constantly monitored in order to prevent imbalances that could cause further damage secondary to iatrogenic neural tissue healthy, especially with regard to hypercapnia. Usually the patient undergoing craniotomy for meningioma recovers in a few hours with a good neurological function and this type of surgery can ensure a long median survival time. In cases where the meningioma is particularly aggressive, so in case of intermediate or high histological grade, or in case of injury in locations hardly reached, the surgical procedure can be completed by adjuvant radiation therapy. Also in this case we prefer a type of fractionated stereotactic radiation therapy, or while fractionation doses in a number of sessions, these are provided with the accuracy of stereotaxy, thereby sparing the maximum surrounding healthy tissue and delivering the highest possible dose to the tumor bed.

 ✩ CERVICAL STABILIZATION

In the case of cervical vertebral instability in dogs of large size, various techniques of stabilization have been proposed. It is possible to reach a good cervical stabilization using a dynamic intervertebral distractor titanium inserted under fluoroscopic guidance into the intervertebral space concerned, previously subjected to discectomy by Caspar pliers and tungsten carbide cutter.

At the Foundation the intervention has been improved over time adding to this means of synthesis (in the other hand is sufficient to guarantee the distraction), the inclusion of unicortical cancellous screws 6.5 mm in diameter in the vertebral bodies related to stabilization, made solid resin with antibiotic surgery. 

In our opinion, on the one hand the intervertebral cage ensures the maintenance of a good distraction, the screws in vertebral bodies allow a good contrast of the forces offlexion-extension. In order of the well position the implant should be under intraoperative fluoroscopic control. In the post-operative period, in orderto support, a soft collar is applied recommending a rest for at least 2 months.

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