Modified scalp block and total intravenous anesthesia for frontal craniotomy in a dog with a meningioma: a technical case report

Abstract Intracranial meningiomas are among the most common primary central nervous system tumors in dogs, and surgical resection is associated with prolonged survival for rostrotentorial lesions. This report describes the anesthetic and surgical management of a dog undergoing frontal craniotomy using a modified scalp block technique. A 9-year-old male Shih Tzu with seizures and forebrain signs was diagnosed with a rostrotentorial intracranial mass compatible with meningioma on computed tomography. Frontal craniotomy was performed under total intravenous anesthesia with propofol target-controlled infusion combined with bilateral frontal and modified zygomaticotemporal scalp block using bupivacaine. The modified technique involved caudal needle insertion along the zygomatic arch with dorsomedial redirection toward the orbital ligament and fractionated anesthetic deposition. Cardiovascular parameters remained stable during the four major nociceptive events analyzed—skin incision, muscle dissection, craniotomy, and durotomy—with no clinically relevant increases beyond approximately 20% of stabilized post-induction baseline values; no rescue analgesia or adjustments in target propofol plasma concentration were required intraoperatively. During cranioplasty, the patient developed hemodynamic instability associated with blood loss, which improved after transfusion therapy. Postoperative recovery was satisfactory, with neurological improvement and no immediate complications. The association of total intravenous anesthesia and modified scalp block may represent a feasible neuroanesthetic strategy for canine craniotomy, contributing to nociceptive control and cardiovascular stability. Further studies are needed to validate the technique and its analgesic efficacy.