Jada the Siamese cat saved by challenging brain surgery at Veterinary Teaching Hospital
October 3, 2023
Thanks to a four-hour double operation, including complex brain surgery, Jada, a 3-year-old Siamese cat, is beginning to return to her old self.
Using an MRI and a "real-time" CT scan called Brainsight, the first of two surgical teams with the Virginia-Maryland College of Veterinary Medicine removed a brain infection and was swiftly followed by a second team to clear up the original severe ear infection that had spread into the brain, causing the infection.
Jada's owners, Tian Xu and Jamie Liang, graduate students at Virginia Tech, noticed that she had balance and mobility problems and tended to lean on her right side.
They took Jada to the Veterinary Teaching Hospital (VTH) as an emergency due to her worsening condition. It was discovered that she had developed a middle ear infection, which was promptly treated with a thorough ear cleaning and a prescription for antibiotics.
However, despite the treatment, Jada's symptoms persisted. She continued to struggle with balance and had difficulty getting up. Concerned about her worsening condition, the veterinary team conducted further investigations. It became apparent that Jada was experiencing a neurological issue, leading to the decision to perform an MRI to pinpoint the exact cause of her deficits.
"We started with a neurologic examination and found that she had a lot of deficits that localized somewhere intracranially. Trying to decide further what was going on needed an MRI,” said neurology resident Christina Vezza.
The MRI revealed that Jada's ear infection had spread to her brain. The infection created an abscess—a mass-like pocket of pus—in her brain.
With the owner's support, the decision was made to proceed with surgery to remove the infection from Jada's brain.
Using the MRI and a CT scan, assistant professor of neurology Richard Shinn and neurology resident Christina Vezza formed a surgical plan. The location of the abscess posed a unique challenge—because of the cat's cranial anatomy, the team had to enter the skull at a different angle, which made visualization difficult.
"One of the unique aspects of this case was the location of the abscess in the cat's brain” Shinn said. “Due to the cat's anatomy, accessing the abscess was extremely challenging. If we attempted to approach it from below, the mandible [jawbone] would obstruct our path, requiring us to open the jaw to gain access. However, in cats, most of the blood flow to the brain originates from this region. Opening the jaw would disrupt the blood flow, leading to additional complications."
"We had to approach the abscess from the top, which made visualization significantly more difficult. The Brainsight proved to be invaluable in aiding our procedure."
The team performed surgery with the aid of Brainsight, a navigation system that helps guide the surgery. Brainsight can be used to detect the location of an instrument, creating a visualization that appears like a real-time CT scan to guide the surgeon.
Only a few universities and private practices worldwide have implemented this system. There is a learning curve involved in understanding how to set it up effectively, and it requires a significant investment in resources and time. As a result, the adoption of this system is limited, as it is not frequently used or seen in many educational and healthcare settings.
"The visualization was still quite difficult. But we were able to use this instrument to say yes, this is absolutely where the abscess is, so we could start taking it out without worrying,” said Shinn.
After nearly three hours of intense work, Jada was only halfway there.
Following the brain surgery, Justin Ganjei, adjunct assistant professor of small animal surgery, and his team performed a second surgery to clean Jada's middle ear and remove a polyp in the nasopharynx area.
Jada had to be repositioned for the correct angle for the ear surgery.
"So Jada had two issues, “ Vezza said. “One was in the brain, and the other was in the ear canal. Everything started from the middle ear, and the infection spread into the brain."
"We had to go almost like in reverse, sort out the brain problem and then sort out the ear infection problem," said Vezza.
Cats with brain abscesses tend to have a poor prognosis, and in addition to antibiotics, Jada still has follow-up appointments and another MRI in the future. However, her coordination is improving, and she can jump and be more active.
Shinn said the teams are delighted with her progress and how she's doing.
"On her most recent checkup, she's walking around much better, displaying increased coordination,” Shinn said. “Previously, she would attempt to jump but often ended up falling. However, now she's become more coordinated. Her incision has healed well also.”
According to Xu and Liang, it was a relatively easy decision because of Jada's young age to do the surgery. "We are very glad. Both Jaime and I agree about the surgery; we think we've made the right call," said Xu.
Shinn is hopeful that if there are more successful cases of cats undergoing brain surgery in the future, the existing literature on options available for such cats due to poor outcomes might change. This could open the possibilities for other treatments. However, further research and successes are needed to advance the current literature.
As alums and current students at Virginia Tech, Xu and Liang are no strangers to the university's excellence. Liang is pursuing her master's in health and nutrition. Xu is a doctoral student at the veterinary college's Department of Biomedical Sciences and Pathobiology.
"We are very grateful for all the staff's help and encouragement," Xu said.
As for Jada, despite enjoying all the loving attention from the faculty, staff, and many students, she seems glad to be home.