An historical context of modern principles in the management of intracranial injury from projectiles

Agarwalla, Pankaj K.; Dunn, Gavin P.; Laws, Edward R.

doi:10.3171/2010.2.focus1038

Cited by 26 publications

(18 citation statements)

References 74 publications

(90 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further consolidation occurred in the realm of operative technique as well. Although the importance of removing impacted bone fragments was recognized by WWI and WWII neurosurgeons [9,11,22] , it would not become routine practice until the end of the Vietnam War -secondarily, if necessary [9] . Another technical improvement occurred with the introduction and use of open debridement in the treatment of fungating cerebritis, a problem that had bedeviled soldiers and combat neurosurgeons for decades [11,24] .…”

Section: Korean and Vietnam Wars (1950s-1970s): The Helicopter Fungamentioning

confidence: 99%

“…The evolution of combat weaponry during this time period, however, played a key role in creating the need for large numbers of cranial surgeons during WWI. Immediately prior to the eruption of WWI, significant advances in munitions technology and war methodology in the form of the development and widespread employment of automatic rifles and heavy artillery would provide the conditions from which an overwhelming amount of penetrating cranial trauma would soon emerge [6,9] . Consequently, significant progress was made in the description and treatment of these penetrating cranial traumas during WWI.…”

Section: World War I (1914-1918): Head Injuries and The Rise Of Neuromentioning

confidence: 99%

“…During the initial phases of the Korean War, significant delays in definitive neurosurgical treatment were encountered, leading to unacceptably high infection and complication rates [9,18] . Dissatisfied with these delays and drawing from the successes of Cairns's experience with MNSUs in WWII, a new two-tiered casualty evacuation system was created and enacted shortly after the outbreak of war [9,18] . This new system incorporated a recent innovation in aeronautics: the helicopter [23] .…”

Section: Korean and Vietnam Wars (1950s-1970s): The Helicopter Fungamentioning

confidence: 99%

See 2 more Smart Citations

Impact of 20th Century Wars on the Development of Neurosurgery

Dowdy

Pait²

2016

War Neurology

View full text Add to dashboard Cite

The treatment of neurosurgical casualties suffered during the wars of the 20th century had a significant impact on the formation and early growth of neurosurgery as a specialty. This chapter explores how the evolution of military tactics and weaponry along with the circumstances surrounding the wars themselves profoundly influenced the field. From the crystallization of intracranial projectile wound management and the formal recognition of the specialty itself arising from World War I experiences to the radical progress made in the outcomes of spinal-cord-injured soldiers in World War II or the fact that the neurosurgical training courses commissioned for these wars proved to be the precursors to modern neurosurgical training programs, the impact of the 20th century wars on the development of the field of neurosurgery is considerable.

show abstract

Section: Korean and Vietnam Wars (1950s-1970s): The Helicopter Fungamentioning

confidence: 99%

Section: World War I (1914-1918): Head Injuries and The Rise Of Neuromentioning

confidence: 99%

Section: Korean and Vietnam Wars (1950s-1970s): The Helicopter Fungamentioning

confidence: 99%

See 1 more Smart Citation

Impact of 20th Century Wars on the Development of Neurosurgery

Dowdy

Pait²

2016

War Neurology

View full text Add to dashboard Cite

show abstract

“…As an alternative, the use of an implantable biomaterial may provide a feasible method of drug delivery in clinical scenarios that already require a neurosurgical procedure. For example, severe penetrating brain injury (PBI) resulting from bullets or shrapnel often requires debridement surgery to remove bone and projectile fragments that have entered the brain (Agarwalla et al, 2010). Delivery of a therapeutic agent at the time of a surgical intervention after PBI may provide benefit in mitigating further injury or promoting regeneration.…”

Section: Introductionmentioning

confidence: 99%

Treatment of penetrating brain injury in a rat model using collagen scaffolds incorporating soluble Nogo receptor

Elias

Spector

2012

J Tissue Eng Regen Med

View full text Add to dashboard Cite

Injuries and diseases of the central nervous system (CNS) have the potential to cause permanent loss of brain parenchyma, with severe neurological consequences. Cavitary defects in the brain may afford the possibility of treatment with biomaterials that fill the lesion site while delivering therapeutic agents. This study examined the treatment of penetrating brain injury (PBI) in a rat model with collagen biomaterials and a soluble Nogo receptor (sNgR) molecule. sNgR was aimed at neutralizing myelin proteins that hinder axon regeneration by inducing growth cone collapse. Scaffolds containing sNgR were implanted in the brains of adult rats 1 week after injury and analysed 4 weeks or 8 weeks later. Histological analysis revealed that the scaffolds filled the lesion sites, remained intact with open pores and were infiltrated with cells and extracellular matrix. Immunohistochemical staining demonstrated the composition of the cellular infiltrate to include macrophages, astrocytes and vascular endothelial cells. Isolated regions of the scaffold borders showed integration with surrounding viable brain tissue that included neurons and oligodendrocytes. While axon regeneration was not detected in the scaffolds, the cellular infiltration and vascularization of the lesion site demonstrated a modification of the injury environment with implications for regenerative strategies.

show abstract

“…Prior to the outbreak of WWI, the changes in the shape and weight of projectiles as well as the increasing reliance on heavy artillery and automatic rifles spawned the conditions from which a massive amount of penetrating cranial traumas would emerge. 2,35 Although Harvey Cushing's 1905 lecture "The Special Field of Neurological Surgery" served as a declaration of sorts regarding the development of neurosurgery, 25 the field had yet to be fully accepted as a distinct subspecialty among members of the existing medical establishment as WWI commenced. Nonetheless, the sheer volume of patients with craniospinal trauma and the exposure of innumerable physicians and personnel to these patients during the war would serve to solidify neurosurgery's position alongside the recognized subspecialties as the war continued to progress.…”

Section: World War I: a Specialty Definedmentioning

confidence: 99%

The influence of war on the development of neurosurgery

Dowdy

Pait²

2014

JNS

View full text Add to dashboard Cite

I would remind you again how large and various was the experience of the battlefield, and how fertile the blood of warriors in rearing good surgeons. Hieronymous BrunscHwig, 16tH century 3Since the dawn of humankind, a symbiotic relationship has existed between casualties of human conflicts and those tasked with the treatment of these casualties. As humankind has developed more effective combat weaponry and methodology, so has humanity evolved in its ability to treat the resultant wounds of war. This relationship has been a critical factor behind the development of medicine and surgery and, in the nascent field of neurosurgery, an important driving force in the early growth of the specialty. Prehistoric Times Until the 19th Century: From Ancient Trephinations to the Beginning of the Modern AgeThe discovery of a trephined Peruvian skull by Squier in the 1860s and the excavation of Neolithic skulls in Central France by Prunières in the 1870s showcased the art of trephination to an increasingly modern and scientific world.19 Anthropologists subsequently sought to determine the circumstances under which prehistoric peoples would venture into the intracranial spaces as early as 10,000 years ago. Several theories were proposed. Paul Broca postulated in 1874 that these ancient trephinations were performed mostly in children for relief of evil spirits. 19 Sir Victor Horsley disagreed, advancing his theory in 1887 that these ancient forays into the skull were for the relief of epilepsy due to depressed skull fractures overlying the motor cortex. 29 After investigation of a large number of trephined Peruvian skulls excavated near an ancient fort, paleopathologist Roy Moodie concluded that the practice was most commonly used for the treatment of battle injuries. 48 Although it is not completely certain why ancient trephiners on different continents chose to delve into the cranial contents millennia before aseptic principles and a modern understanding of cerebral function existed, the relief of war wounds was one of the primary indications.The art of cranial surgery was thought to have remained primarily in the purview of primitive, prescientific surgeons until discovery of the Edwin Smith Surgical Papyrus in 1862 and its subsequent translation in 1930 (Fig. 1). This historic document provided the first evidence of a decidedly scientific approach to the cranial contents that dated back to approximately several thousand years BC. In fact, this Egyptian treatise on battle surgery provides many of the first descriptions of neuroanatomical structures as well as being the first known document to chronicle the The influence of war on the development of neurosurgery Historical vignetteJustin DowDy, M.D., anD t. Glenn Pait, M.D. Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, ArkansasThe treatment of craniospinal war wounds proved to be a significant driving force in the early growth of neurosurgery as a specialty. This publication explores the historical relationship between the evolution of ...

show abstract

An historical context of modern principles in the management of intracranial injury from projectiles

Cited by 26 publications

References 74 publications

Impact of 20th Century Wars on the Development of Neurosurgery

Impact of 20th Century Wars on the Development of Neurosurgery

Treatment of penetrating brain injury in a rat model using collagen scaffolds incorporating soluble Nogo receptor

The influence of war on the development of neurosurgery

Contact Info

Product

Resources

About