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Louie was referred to the Neurology service at the Queen Mother Hospital after being involved in a road traffic accident. His owners actually saw the vehicle hitting Louie and rushed him to their local veterinary surgeons. Louie had suffered severe trauma to his head but thankfully not many other significant injuries. After initial stabilisation his vets discussed his condition with the QMH Neurology team and decided that referral would offer the best chance for saving Louie's life.
The Neurology team were ready and waiting for Louie when he arrived. After initial assessment and consultation with his owners it was decided that a CT scan would provide the quickest and most useful information about the degree of damage to Louie's skull, as well as information about any brain damage suffered.
The scan revealed a cominnueted depressed fracture of the skull, where the skull is broken into a number of pieces which push into the nasal cavity and the brain. A large portion of Louie's brain was affected by his broken skull pieces, and if left pressing on the brain tissue and inhibiting blood flow, these pieces would cause ongoing damage to the brain. The best chance for Louie to recover well would be to remove the bone fragments in surgery and relieve the pressure to allow normal blood flow in the brain to resume. The brain would also be checked during surgery and any pieces too severely damaged to heal would be removed. Damaged or dying brain tissue heals very poorly and causes further damage to surrounding healthy tissue.
The surgery lasted around three hours during which surgeon Rodolfo Cappello used an operating microscope to improve his view of the small bone fragments he had to remove from the brain tissue. The microscope also allowed the nurses and students to watch what was happening deep in the surgical field, as the microscope linked to a camera and screen in theatre. Louie was left with a small hole in his skull, but as there is a thick layer of muscle and skin to protect his brain, the hole should not cause any problems. However it is vital in the first weeks after surgery that Louie not receive any more knocks to his head!
Recovery from brain surgery is un-predictable. Some patients stay in ICU on a ventilator for many hours or days before the swelling and inflammation in their brain settles down. Louie however recovered very well and within hours of surgery was making an effort to move. The day following surgery he was able to get up and walk around his cot in the ICU. Two days after surgery he left ICU and was allowed outside for short walks on the grass - initially supported in a sling but rapidly under his own strength.
The trauma to his brain however, affected his balance and sense of direction for a prolonged time after the accident. Even though he could walk without the sling he tended to walk in circles rather than a straight line. Over the weeks after surgery this became less and less noticeable and now he only does the occasional little circle when very excited or when he changes direction in a hurry.
