DOI : https :// doi . org / 10.56496 / JING5865

Amy Rose Hogan , RVN

North Downs Specialist Referrals , Surrey

ENVELOPE amy . hogan @ sky . com

Amy completed her level 3 diploma in small animal veterinary nursing and qualified as an RVN in September 2022 . She has since joined North Downs Specialist Referrals in Surrey , as part of the post-registration programme , to further her knowledge and clinical skills . She enjoys the diversity offered by the rotating role , and has a particular interest in anaesthesia , in-patient care and physiotherapy , which she hopes to study further in the future .

ABSTRACT Meningioma is the most common form of brain tumour in cats . With all intracranial tumours there is an increased risk of elevated intracranial pressure ( ICP ), which may potentially be exacerbated by undergoing general anaesthesia for diagnostic or surgical purposes .

This nursing care analysis outlines the nursing interventions implemented to manage ICP during the perioperative period of a cat undergoing craniotomy surgery to remove a meningioma , including recommendations for future practice .

Keywords intracranial pressure , craniotomy , meningioma , mean arterial pressure , end-tidal carbon dioxide , partial pressure of carbon dioxide

Introduction

Meningiomas account for 59 % of feline primary brain tumours [ 1 ] . They are extra-axial tumours that develop within the meninges , the layers of tissue that cover the brain and spinal cord to support and protect the central nervous system [ 2 ] .

Advanced imaging techniques , such as magnetic resonance imaging ( MRI ), are used to diagnose these tumours . They require the use of general anaesthesia to prevent excessive patient movement . General anaesthesia will also be required for curative treatment , including craniotomy and radiotherapy . Owing to the detrimental effects of increased intracranial pressure ( ICP ), careful patient handling and anaesthetic management are imperative and will be discussed at length in this case analysis .

What is ICP ?

ICP is the pressure exerted within the closed cavity of the cranium , which consists of the parenchyma , cerebral blood vessels and cerebrospinal fluid ( CSF ) [ 3 ] . If there is a disruption to the normal balance of these components , such as the presence of a brain tumour , there will be a subsequent increase in ICP [ 4 ] . In a stable patient , ICP is in the range of 5 – 12 mmHg [ 5 ] .

Methods of direct ICP measurement currently used in human medicine have yet to be adopted by veterinary practice , due to the high cost of the fibreoptic system and the invasive method required to place the transducer [ 5 ] . Therefore , reliance is placed on physiological and neurological indicators of ICP .

36 Veterinary Nursing Journal