PMC9178977_01
(a) CT mid-sagittal reconstruction soft tissue algorithm showing severe cranioschisis with complete absence of the frontal bone, including the frontal sinuses and both meninges and brain tissue protruding through the defect consistent with meningoencephalocoele. Note a subjectively smaller-than-normal caudal cranial fossa and flattening of the cerebellum (black star); and (b) CT transverse plain of the same images at the level of the frontal lobe
10.1177_20551169221098940-fig2.jpg
PMC9178977_01_10.1177_20551169221098940-fig2.jpg
fig2-20551169221098940
The caudal cranial fossa was subjectively small, and the cerebellum appeared flattened dorsoventrally (Figure 2).
(a) Three-dimensional printed skull mould of the cranium of the cat at 6 months of age; and (b) the tailor-made polysulfone implant
10.1177_20551169221098940-fig3.jpg
PMC9178977_01_10.1177_20551169221098940-fig3.jpg
fig3-20551169221098940
A three-dimensional printed reconstruction of the cat's skull helped to adapt a polysulfone tailor-made implant (Beta Implants; Pontevedra) for a perfect fit to cover the bone defect (Figure 3).
PMC9178977_02
(a) Intrasurgical image showing the exposed protruding brain tissue after durectomy; and (b) intraoperative image showing the implant placement and fixation with cerclages within predrilled holes
10.1177_20551169221098940-fig4.jpg
PMC9178977_02_10.1177_20551169221098940-fig4.jpg
fig4-20551169221098940
The exposed brain was hard and thickened, and no gyri were identifiable (Figure 4a). The implant was anchored to the skull with four 0.6 mm cerclages in the predrilled holes (Figure 4b).
Postoperative image of the cat a few months after surgery, showing acceptable cosmetic results
10.1177_20551169221098940-fig5.jpg
PMC9178977_02_10.1177_20551169221098940-fig5.jpg
fig5-20551169221098940
The skin excess was removed using Metzembaum scissors to achieve a cosmetically adequate appearance (Figure 5).
(a) Immediate postoperative CT mid-sagittal reconstruction soft tissue algorithm showing the tailor-made implant in place. Note the presence of postoperative pneumocephalus. (b) CT transverse plain of the same images at the level of the frontal lobe
10.1177_20551169221098940-fig6.jpg
PMC9178977_02_10.1177_20551169221098940-fig6.jpg
fig6-20551169221098940
(a) Microscopic transverse section of the abnormal protruding cerebral cortex (NeuN immunohistochemistry counterstained with haematoxylin). Note the absence of sulci and abnormal organisation of neuronal laminae with irregular density of neuronal cell bodies. (b) Microscopic transverse section of the abnormal protruding tissues (haematoxylin and eosin staining). Note leptomeningeal thickening (*) and cell proliferation forming fibrous solid or concentric structures. The adjacent cortical cerebral tissue shows abnormal distribution of neuronal cell bodies
10.1177_20551169221098940-fig7.jpg
PMC9178977_02_10.1177_20551169221098940-fig7.jpg
fig7-20551169221098940
Inflammation was not a feature (Figure 7).
(a) Twelve-month postoperative CT mid-sagittal reconstruction soft tissue algorithm showing complete resolution of the postoperative pneumocephalus and correct implant positioning. (b) CT transverse plain of the same images at the level of the frontal lobe
10.1177_20551169221098940-fig8.jpg
PMC9178977_02_10.1177_20551169221098940-fig8.jpg
fig8-20551169221098940
At that point, a recheck CT was performed observing that the implant was still in the same position and the pneumocephalus, present in the CT immediately postsurgery, had resolved (Figure 8).