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Victoria Kymm 1, Youngjin Jeon 2, Il-Hwa Hong 3, Yoonho Roh 1
Background
Caudal fossa gliomas are rare brain tumors in dogs, and surgical management remains a challenge due to their deep location and critical surrounding anatomy. While the telovelar approach is well documented in human neurosurgery for accessing the fourth ventricle, its use in veterinary medicine has been limited to resecting choroid plexus tumors and meningiomas. This report describes the first known case of a caudal fossa glioma in a dog treated surgically using the telovelar approach followed by radiation therapy (RT), aiming to assess its feasibility and outcome.
Methods
A 7-year-old male toy poodle presenting with tetraparesis and seizures was diagnosed via MRI and CT with a 1.4 × 1.4 × 2.2 cm mass in the fourth ventricle and caudal brainstem. The patient underwent a telovelar craniotomy and partial tumor resection. Postoperative histopathology and immunohistochemistry confirmed a high-grade undefined glioma. Radiation therapy was administered postoperatively in 20 fractions (total dose 50 Gy). Postoperative imaging and clinical monitoring were conducted to assess residual disease and recovery.
Results
Despite extensive tumor infiltration and intraoperative hemorrhage, partial resection was achieved. Postoperative symptoms (seizures, tetraparesis) improved, and by day 15, the dog exhibited normal gait. MRI showed residual tumor volume reduced to 19% of the original size. The patient completed 20 sessions of RT. However, the dog died 91 days postoperatively, and the cause of death remained undetermined due to the absence of a necropsy. Histopathology revealed extensive necrosis and pseudo-palisading, confirming a high-grade glioma.
Limitations
This is a single-case report, limiting generalizability. Complete tumor resection was not possible due to the infiltrative nature and deep location. Lack of postoperative imaging after RT and limited follow-up with the owner hindered evaluation of long-term treatment efficacy. Analgesic choices were constrained by regulatory restrictions in Korea, precluding the use of potent opioids like fentanyl. The cause of death could not be determined due to the absence of a necropsy.
Conclusions
The telovelar approach provided effective access for partial resection of a caudal fossa glioma in a dog, enabling clinical improvement and completion of postoperative RT. Although long-term survival was not achieved, this method may offer clinical benefits in terms of neurological recovery and quality of life. The case underscores the need for further studies to refine surgical techniques and evaluate the impact of combined surgical and adjuvant therapies in veterinary neuro-oncology.
Perioperative images. (A) After separating the skin and muscle, the occipital bone (arrowhead) and C1 vertebra (asterisk) were exposed. (B) Following suboccipital craniotomy and partial dorsal laminectomy of C1, the tumor (asterisk) and cerebellar vermis (arrowhead) were covered by the dura mater. (C) After incising the dura mater, the dusky tan-to-pink color of abnormal tissue (asterisk) and the cerebellar vermis with a clear pink color (arrowhead) were exposed. (D) The tumor was infiltrative (asterisk), making it difficult to distinguish it from normal tissue. The cerebellar vermis was discolored (arrowhead) due to the application of absorbable oxidized regenerated cellulose (arrow). Absorbable oxidized regenerated cellulose with absorbed blood (arrow). (E) After partial tumor removal, remnants of the tumor (asterisk) were still observed. (F) The application of flowable thrombin material (arrow) for hemostasis after tumor resection. Cd, Caudal; Cr, Cranial; Lt, left; Rt, right.
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