V Vol. 22, No.
8 August 2000
HOW I TREAT...
Primary Brain Tumors
in Dogs and Cats
Texas A&M University
C. W. Dewey, DVM, MS
A. Bahr, DVM, MS
J. M. Ducoté, DVM
P rimary brain tumors include neoplasms that arise
from brain parenchymal tissue (e.g., glial cells,
neurons), cells comprising the outer and inner
lining of the brain (meninges and ependyma, respec-
tively), and vascular elements (e.g., choroid plexus).
Brain tumors excluded from this category (i.e., sec-
ondary brain tumors) include metastatic tumors, nasal
and frontal sinus tumors, calvarial tumors (e.g., multi-
lobular osteochondrosarcoma), and pituitary tumors.1–5
Meningiomas and gliomas are the most common pri-
mary brain tumors found in dogs and cats, although
other primary brain neoplasms (e.g., choroid plexus tu-
mors, ependymomas) are occasionally seen. Cats are un-
likely to develop brain tumors other than meningioma,
but gliomas are frequently diagnosed in dogs. Astrocy-
toma and oligodendroglioma are the two major types of
gliomas that occur in dogs. Brain tumors exert their
pathologic effects both by directly encroaching on
and/or invading brain tissue and by such secondary ef-
fects as peritumoral edema, inflammation, obstructive
hydrocephalus, and hemorrhage. Treatment of dogs and
cats with primary brain tumors can be divided concep-
tually into supportive and definitive therapy. For the
purposes of this discussion, supportive therapy refers to
treatments aimed at the alleviation of secondary effects
of the tumor, and definitive therapy includes therapeu-
tic modalities directed toward diminishing tumor vol-
ume or eliminating the tumor1–5 (Figure 1).
CLINICAL SIGNS
Middle-aged to older pets are more likely to develop
brain tumors than are younger (less than 5 years of age)
J. R. Coates, DVM, MS
M. A. Walker, DVM
animals. The median age for dogs to be diagnosed with
a brain tumor is 9 years, and the median age for cats is
over 10 years. Although certain breed and sex predilec-
tions have been associated with specific tumors (e.g.,
brachycephalic dogs and gliomas, male cats and menin-
giomas), brain tumors can affect any breed and either
sex. Historical and presenting clinical signs of patients
with tumors are variable and reflect the location, size,
and secondary effects (e.g., edema, hemorrhage) of the
neoplasm1,4,6–10 (see Clinical Signs Associated with Brain
Tumors in Dogs and Cats).
In dogs with brain tumors, the most common pre-
senting clinical sign of dysfunction is seizure activity. In
cats, behavior changes are most commonly report-
ed.1,4,6–10 With the exception of seizure activity, the on-
set of clinical signs of neurologic dysfunction is often
insidious over weeks to months, especially with menin-
giomas. Owners of pets with meningiomas often realize
retrospectively that their pets’ behavior had changed
from months to over a year before diagnosis. In senior
pets, early, nonspecific changes in behavior (e.g., lethar-
gy) are often attributed initially to “old age.”1,2,4
Brain tumor patients occasionally experience sub-
acute to acute development of neurologic dysfunction.
Because of the increasing tumor volume, these animals
may suffer sudden exhaustion of brain compensatory
mechanisms; other potential explanations include tu-
mor-associated acute hemorrhage or obstructive hydro-
cephalus. Cerebral/diencephalic (forebrain) tumors are
encountered more frequently than are tumors of the
midbrain through the medulla (brain stem, excluding
the diencephalon) or the cerebellum.3,6–10 Forebrain neo-
Compendium August 2000 Small Animal/Exotics

Treating Dogs and Cats with Primary Brain Tumors

Suspected brain lesion

Signalment, history, physical

examination, neurologic examination

Blood work (complete blood count,

chemistry profile), urinalysis, thoracic
radiography (metastasis check)

No detectable Detectable
abnormalities abnormalities

Resolvable Nonresolvable
Supportive
Brain imaging (computed therapy
tomography, magnetic
resonance imaging)

Probable No brain Brain lesion, causes other

brain tumor lesion than neoplasia suspected

Cerebrospinal
fluid analysis

Amenable to Not amenable to Consistent with brain Inconsistent

surgical resection surgical resection tumor (lesion present with brain
on imaging) tumor

Surgery alone Surgery plus adjunctive Chemotherapy Radiation Consider other

(e.g., for feline definitive therapy therapy differentials for
meningioma) (e.g., radiation therapy) encephalopathy

Key
Assessment Findings Treatment Diagnosis

Figure 1—Algorithm for decision making in the treatment of dogs and cats with primary brain tumors.
Small Animal/Exotics
Clinical Signs Associated with
Brain Tumors in Dogs and Cats
Forebrain (cerebrum/diencephalon) tumors
■ Seizures
■ Behavior changes
■ Circling
■ Head-pressing
■ Visual deficits
■ Proprioceptive deficits with normal to near-normal gait
■ Hemiinattention (hemineglect) syndrome
■ Neck pain
Brainstem (midbrain through medulla) tumors
■ Severe disturbances of consciousness
■ Gait and/or proprioceptive deficits
■ Cranial nerve III to XII dysfunction
Cerebellar tumors
■ Ataxia
■ Dysmetria
■ Intention tremors
■ Menace deficits with normal vision
plasms tend to cause clinical signs of dysfunction such
as seizure activity, behavior changes, circling (typically
to the side of the lesion), head-pressing, visual deficits,
and hemiinattention (hemineglect) syndrome.1–6,11,12 Pa-
tients with hemiinattention syndrome ignore environ-
mental stimuli on the side oppo-
site the forebrain lesion.12 They
also tend to eat from one side of
the food bowl (i.e., the side of
the lesion) and have difficulty
localizing sound and noxious
stimuli applied to the side oppo-
site the lesion. In addition, pro-
prioceptive placing deficits and
neck pain are often appreciable
on neurologic examinations of
dogs or cats with forebrain tu-
mors.13 Neoplasms of the brain
stem from midbrain through
medulla typically cause severe al-
terations of consciousness, dys-
function of cranial nerves (other
Figure 2—Computed tomogram (dorsal view) of an
than cranial nerves I and II), and intracranial meningioma in a cat.
obvious gait and proprioceptive
HEMIINATTENTION SYNDROME ■ BRAIN NEOPLASIA ■ MENINGIOMAS ■ GLIOMAS
Compendium August 2000
abnormalities. Cerebellar tumors may cause
such clinical signs as ataxia, dysmetria, inten-
tion tremors, and menace deficits with normal
vision.1–6
DIAGNOSIS
Brain tumors should be highly suspected in el-
derly dogs or cats with progressive signs of brain
dysfunction. Brain neoplasia should be consid-
ered high on the differential diagnosis list for any
dog or cat that exhibits seizure activity after 5
years of age, even if the patient is neurologically
normal between seizure episodes.6,11 Definitive
diagnosis of a brain tumor requires a tissue sam-
ple from the neoplasm, although a confident
tentative diagnosis can often be attained by
imaging the brain tumor.14–16 Before pursuing
advanced imaging, however, basic blood work
(complete blood count, serum biochemistry pan-
el) and urinalysis should be conducted. Thoracic
radiographs should be obtained to help rule out
the possibility of metastatic cancer. Computed
tomography (CT) and magnetic resonance imag-
ing (MRI) are commonly used to diagnose brain
tumors. Specific types of brain tumors may vary
in their appearance with these imaging modali-
ties. However, some typical features distinguish
meningiomas from gliomas. Meningiomas tend
to have a broad-based, extraaxial attachment
(these tumors arise from the periphery of the brain and
move inward), exhibit distinct tumor margins (menin-
giomas tend to primarily displace rather than invade
brain parenchyma), and contrast enhance uniformly (Fig-
ure 2). Gliomas tend to arise from an intraaxial location
(from within the substance of the
brain, moving outward), often
lack distinct tumor margins (they
tend to infiltrate brain parenchy-
ma), and typically contrast en-
hance poorly and nonuniformly
(Figure 3).14–16
Stereotactic CT-guided biopsy
of canine brain tumors has re-
cently been described.17,18 With
this new technology, a definitive
diagnosis can be obtained at the
time of imaging without the
need for major intracranial
surgery. 17,18 The value of cere-
brospinal fluid (CSF) analysis in
brain tumor patients is debatable
and often a matter of clinician
preference. CSF analysis is often
 Compendium August 2000 Small Animal/Exotics

abnormal in patients with brain tu- to reach therapeutic serum concentra-

mors.19 However, the results of CSF tions. At Texas A&M University, we
analysis in these patients are extremely typically use a loading dose of 125
variable and nonspecific and are, there- mg/kg/day divided twice daily for 5
fore, unlikely to contribute meaning- days, then switch to a maintenance
ful diagnostic information in most cas- dose of 35 mg/kg/day, divided twice
es. In addition, procuring CSF may daily. Some animals may require a com-
increase the risk for brain herniation bination of phenobarbital and KBr for
because of tumor-associated increased adequate seizure control.20 Although
intracranial pressure (ICP).1–5 Our clin- oral diazepam is often an effective
ical impression is that this increased maintenance anticonvulsant drug in
risk is usually small, especially if the cats, we avoid using it in cats because it
patient is hyperventilated and admin- has been associated with acute fatal
istered mannitol before obtaining the hepatic necrosis.21,22 Furthermore, alter-
CSF. At Texas A&M University, we native therapies (e.g., phenobarbital
usually do not pursue CSF analysis if and KBr) are available.
the CT or MRI results strongly sug- Supportive therapy usually success-
gest neoplasia. However, CSF evalua- fully (within several days) improves the
tion may occasionally be helpful in neurologic status and quality of life of
distinguishing inflammatory lesions Figure 3—Magnetic resonance image brain tumor patients. Clinicians must
(e.g., granulomatous meningoenceph- (axial view) of an intracranial glioma emphasize to clients the limitations of
alitis) from gliomas. in a dog. (Courtesy of Brian Poteet, supportive therapy. Supportive therapy
Gulf Coast Veterinary Specialists, diminishes the clinical manifestations
THERAPY Houston, Texas) caused by secondary effects of the tu-
Supportive mor. However, this therapy has no di-
Supportive therapy is usually recom- rect effect on tumor growth. Contin-
mended regardless of whether the client elects to pursue ued tumor growth will eventually outstrip the ability of
definitive therapy (see Modes of Therapy for Brain Tu- supportive therapy to control clinical signs of disease,
mors in Dogs and Cats). Supportive therapy consists usually within several weeks to several months.1,2,4
initially of an antiinflammatory regimen of oral pred-
nisone (0.5 mg/kg every 12 hours), which can be in- Definitive
creased or decreased depending on patient response. Definitive therapy is directed at long-term control or
Prednisone therapy is believed to exert its beneficial cure by eliminating neoplastic tissue and inhibiting fur-
therapeutic effects by decreasing ICP via relieving tu- ther tumor growth. The goal is to provide the patient
mor-associated edema and decreasing CSF production. with a good quality of life for as long as possible.
If seizure activity is part of Modes of definitive therapy include surgery, radiation
Modes of Therapy the patient’s clinical signs, therapy, and chemotherapy. Surgical removal/debulking
anticonvulsant medication and/or megavoltage radiation therapy are the most
for Brain Tumors
should be prescribed. Oral common definitive therapies for canine and feline brain
in Dogs and Cats phenobarbital (3 to 5 mg/kg tumors.
every 12 hours for dogs; 1 to Surgical intervention for brain tumors is pursued
Supportive therapy
2.5 mg/kg every 12 hours when possible because it can provide a histologic diagno-
■ Prednisone for cats) is usually effective sis that assists in formulating a prognosis and may help
■ Anticonvulsant drugs in lessening seizure frequen- to plan future therapy, if needed. Surgical intervention
Phenobarbital cy and duration. We have can also decrease tumor volume or allow removal of all
Potassium bromide also had success using potas- grossly visible neoplasia and provide some therapeutic
sium bromide (KBr) as a sole benefit to patients by decreasing ICP (decompression ef-
anticonvulsant agent in dogs fect of craniectomy/durotomy). Dogs and cats with tu-
Definitive therapy
and cats with brain tumors. mors located in the cerebrum or cerebellum, especially if
■ Surgery Because of the long half-life in a superficial location, are the best candidates for surgi-
■ Radiation therapy of KBr in dogs and cats, pa- cal intervention (Figure 4). Surgical removal alone is of-
■ Chemotherapy tients may need a loading ten a successful treatment of feline meningiomas because
dose over one to several days these tumors may often be readily excised en masse. Ca-

CEREBROSPINAL FLUID ANALYSIS ■ POTASSIUM BROMIDE ■ LOADING DOSE

Small Animal/Exotics Compendium August 2000

usually maintained on a low dose of prednisone during

radiation therapy.
Chemotherapy has traditionally been regarded as an
ineffective treatment for canine and feline brain tu-
mors, mainly because of the poor ability of most
chemotherapeutic agents to cross the blood–brain bar-
rier even when disturbed by the presence of a tumor.
However, several reports cite the use of nitrosourea
compounds, such as lomustine and carmustine, to treat
canine gliomas. 26–28 These agents readily cross the
blood–brain barrier and are used to treat human in-
tracranial gliomas.26–28 We currently have limited expe-
rience with the use of chemotherapeutic agents in treat-
ing canine gliomas.
Figure 4—Lateral or rostrotentorial craniectomy to remove a
meningioma in a cat. Note the large depression in the brain PROGNOSIS
caused by the tumor. In general, the prognosis for brain tumor patients
treated only with supportive therapy is poor. The ma-
jority of these animals die or are euthanized because of
nine meningiomas are less predictable and often are worsening neurologic dysfunction within the first 3
somewhat invasive compared with feline meningiomas months of initial presentation.1,2,4,29 Except for feline
(Figure 5). However, many of these tumors can be re- meningioma, prognostic information regarding indi-
moved or debulked with good results. Intracranial vidual primary brain tumors is highly variable and
gliomas are characteristically invasive, but some are amen- somewhat conflicting. This is probably because of the
able to surgical removal or debulking.1,2,4,8–10,23–25 We havelack of controlled studies with large numbers of pa-
found intraoperative ultrasonography to be helpful in tients for each of these tumors as well as the diverse bi-
guiding brain tumor surgery, especially when removing ologic behavior of these tumors compared with that of
or debulking gliomas (Figure 6). feline meningiomas. The prognosis for long-term sur-
Radiation therapy is often pursued at Texas A&M vival in cats with intracranial meningiomas is typically
University as an adjunct to surgery of cerebral and cere- good to excellent with surgical removal. Median post-
bellar tumors in dogs and as the sole definitive therapy operative survival rates based on two recent studies9,10
for brainstem tumors. At
Texas A&M, adjunctive
radiation therapy is pur-
sued 2 to 4 weeks follow-
ing surgery depending on
the patient’s clinical sta-
tus. Information concern-
ing radiation therapy for
feline meningiomas is lack-
ing, probably because of
the successful surgical re-
moval of these tumors.
At Texas A&M Universi-
ty, external beam mega-
voltage radiation therapy
(using cobalt-60) is ad-
ministered in fractionat-
ed doses (3.3 Gy on
Monday, Wednesday, and Figure 5—Computed tomogram of an inva-
Friday) for 13 treatments sive intracranial meningioma in a dog (dorsal
view). Note the irregular caudal border of Figure 6—Intraoperative ultrasound image of an
(43 Gy total); 180˚ arc the tumor. intraparenchymal brain tumor (arrow).
therapy is used. Dogs are

RADIATION THERAPY ■ CHEMOTHERAPY ■ BLOOD–BRAIN BARRIER

Compendium August 2000 Small Animal/Exotics

were 21.7 and 27 months. Tumor recurrence has been
estimated at 20% to 25%.9,10 The prognosis for defini-
tive treatment of canine meningiomas is unclear but is
guarded compared with that of the feline disease. The
prognosis for readily resectable meningiomas in dogs is
good, but canine meningiomas are not often as easy to
resect as are feline meningiomas. In one report1,2,4,30–32
of four dogs with intracranial meningiomas, the medi-
an postoperative survival time was 4.6 months.30 In an-
other report of 14 dogs, the median postoperative sur-
vival time was 6.6 months.31
Radiation therapy for canine meningiomas as a sole
therapy has resulted in median survival times of 5 to 9
months.29,33 In a recent report, hypofractionated radia-
tion therapy totaling 38 Gy was administered to 83
dogs with a variety of brain tumors. Only 11 of these
dogs had prior surgery. Median survival times of ap-
proximately 12.5 and 10 months were found for ex-
traaxial (probable meningiomas) and intraaxial (proba-
ble gliomas) tumors, respectively.34
We have treated several canine meningioma patients
with a combination of surgery and radiation therapy,
with survival times exceeding 12 months. The limited
information concerning definitive therapy suggests that
combination therapy may be needed to prolong survival.
In a recent study of 20 dogs that had received adjunctive
radiation therapy for meningiomas following incomplete
surgical resection, the median progression-free interval
was 30 months (mean, 35 months).35 Intracranial gliomas
are considered to be associated with a poor prognosis in
dogs, but little information is available concerning
definitive therapy of gliomas in dogs. Radiation therapy
as a sole treatment in 10 dogs with gliomas resulted in a
median survival of approximately 6 months.33
Several reports indicate that nitrosourea compounds
may play an important role in the chemotherapeutic
treatment of gliomas; survival times ranging from 7 to
11 months have been documented.26–28,33 Data concern-
ing surgical therapy for canine intracranial gliomas are
virtually nonexistent at this time. Hopefully, as more
clients pursue definitive therapy for dogs afflicted with
primary brain tumors and collaborative clinical investi-
gations among veterinary neurosurgical referral centers
are conducted, more meaningful prognostic informa-
tion regarding various treatment modalities for canine
brain tumors will become available.

Your comprehensive guide to

diagnostic ultrasonography
Nautrup and Tobias
■ Sonographic diagnosis in dogs and cats, including
ultrasound, M-mode, pulsed and color Doppler
echography
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and fetal ultrasonography
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computed microfocal tomography, specimen
photography, and line drawings
■ Recognition of the disease process and courses of
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sSmall Animal/Exotics
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About the Authors
Drs. Dewey, Coates, and Ducoté are affiliated with the
Department of Small Animal Medicine and Surgery, and
Drs. Bahr and Walker with the Department of Large Ani-
mal Medicine and Surgery, College of Veterinary Medi-
cine, Texas A&M University, College Station. Drs. Dewey
and Coates are Diplomates of the American College of
Veterinary Internal Medicine (Neurology); Dr. Dewey is
also a Diplomate of the American College of Veterinary
Surgeons. Drs. Bahr and Walker are Diplomates of the
American College of Veterinary Radiology; in addition, Dr.
Walker is a Diplomate of the American College of Veteri-
nary Radiology (Radiation Oncology).