The evolution of the treatment of traumatic cerebrovascular injury during wartime

Bell, Randy S.; Ecker, Robert D.; Severson, Meryl A.; Wanebo, John E.; Crandall, B; Armonda, Rocco A.

doi:10.3171/2010.2.focus1025

Cited by 45 publications

(25 citation statements)

References 35 publications

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“…In contrast, transcranial Doppler (TCD) ultrasonography has been increasingly used over the past few years for diagnosis and monitoring cerebral VSP and implementing therapeutic interventions [7]. TBI and cerebrovascular injury are associated with the severest casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) [8]. From October 1, 2008 the US Army Medical Department TBI program initiated a TCD protocol for examination of head injured patients who were evacuated from the combat theater to receive care at the National Naval Medical Center, the San Antonio Military Medical Center and at the Walter Reed Army Medical Center.…”

Section: Introductionmentioning

confidence: 99%

Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury

Armonda

Tigno

Hochheimer

et al. 2012

Perspectives in Medicine

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KEYWORDSCombat associated wartime traumatic brain injury; Wartime traumatic brain injury; Transcranial Doppler ultrasonography; Cerebral blood flow velocity; Vasospasm; Intracranial pressure Summary Traumatic brain injury (TBI) is associated with the severest casualties from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). From October 1, 2008 the US Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI patients; included patients were retrospectively evaluated for TCD-determined incidence of posttraumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and comprehensive TCD protocol and published diagnostic criteria for vasospasm and raised intracranial pressure (ICP) were applied. TCD signs of mild, moderate and severe vasospasms were observed in 37%, 22% and 12% of patients, respectively. TCD signs of intracranial hypertension were recorded in 62.2%, five patients (4.5%) underwent transluminal angioplasty for post-traumatic clinical vasospasm treatment and 16 (14.4%) had cranioplasty. These findings demonstrate that cerebral arterial spasm and intracranial hypertension are frequent and significant complications of combat TBI, therefore daily TCD monitoring is recommended for their recognition and subsequent management.

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Section: Introductionmentioning

confidence: 99%

Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury

Armonda

Tigno

Hochheimer

et al. 2012

Perspectives in Medicine

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“…6,9 Whereas Aarabi previously described clip ligation for posttraumatic aneurysms, Bell et al 9 have demonstrated the safety and efficacy of newly adopted endovascular techniques. Furthermore, the increased survival afforded by early decompression is providing the backdrop for intensive study of traumatic cerebral vasospasm, which may prove to have significant applications in civilian neurosurgical care.…”

Section: Conflicts In the Modern Middle East: Guerrilla Warfare Earlmentioning

confidence: 99%

“…Furthermore, the increased survival afforded by early decompression is providing the backdrop for intensive study of traumatic cerebral vasospasm, which may prove to have significant applications in civilian neurosurgical care. 6,9 Because the emerging developments are just beginning to find their way to publication, the full story regarding the evolution of wartime neurosurgical techniques shaped by these ongoing conflicts has yet to be fully written.…”

Section: Conflicts In the Modern Middle East: Guerrilla Warfare Earlmentioning

confidence: 99%

The influence of war on the development of neurosurgery

Dowdy

Pait²

2014

JNS

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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 ...

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“…24 Furthermore, whereas it used to take days for soldiers to get from the battlefield to neurosurgical care, the transport time has decreased to less than 1 hour in both Iraq and Afghanistan. 3 Therefore, the number of cranial defects has risen dramatically, forcing new ideas and procedures to be used.…”

Section: Recent Conflictsmentioning

confidence: 99%

The history of military cranioplasty

Bonfield

Kumar

Gerszten

2014

FOC

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There is evidence that the neurosurgical procedure of cranioplasty is as ancient as its better-known counterpart, trephination. With origins in pre-Incan Peru, cranioplasty remains an important reconstructive procedure for modern craniofacial surgery teams to master. Solutions to the often challenging problem of repairing skull defects continue to evolve to improve patient outcomes. Throughout recorded history, advances in cranioplasty have paralleled major military conflicts due to survivorship after trephination or decompressive craniectomy. Primitive skull coverings used in Peru were later replaced during the Middle Ages by grafts obtained in animals and humans. Improved survivorship secondary to advances in anesthesia and battlefield medicine during the Crimean War and the American Civil War allowed the use of tantalum and acrylic cranioplasty to evolve during World Wars I and II. In the modern era of the Iraq and Afghanistan conflicts, greater survivorship after cranial injury due to improvements in protective armor, medical evacuation, and early “far-forward” neurosurgical treatment have occurred. Consequently, the last decade has seen great advancement in cranial defect reconstruction, including custom-fabricated alloplast implants and the emergence of regenerative cranial treatments such as distraction osteogenesis, protected bone regeneration, and free tissue transfers. Comprehensive rehabilitation after neurotrauma has emerged as the new standard of care.

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The evolution of the treatment of traumatic cerebrovascular injury during wartime

Cited by 45 publications

References 35 publications

Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury

Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury

The influence of war on the development of neurosurgery

The history of military cranioplasty

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