Two-year mortality and functional outcomes in combat-related penetrating brain injury: battlefield through rehabilitation

Larkin, M. Benjamin; Graves, Erin K. M.; Boulter, Jason H; Szuflita, Nicholas S.; Meyer, R. Michael; Porambo, Michael; Delaney, John J.; Bell, Randy S.

doi:10.3171/2018.9.focus18359

Cited by 18 publications

(11 citation statements)

References 27 publications

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“…From the military perspective, pTBI was prevalent in recent conflicts in Iraq and Afghanistan and most often results from a blast mechanism. pTBI outcomes in these modern conflicts are better than in past reports, 3–10 most likely because of more aggressive clinical care. 6 Before the conflicts in Iraq and Afghanistan, management in those who survived to reach care included limited surgical debridement and wound closure.…”

Section: Introductionmentioning

confidence: 78%

Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury

Hawryluk

Selph

Lumba‐Brown

et al. 2022

Neurotrauma Reports

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Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.

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Section: Introductionmentioning

confidence: 78%

Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury

Hawryluk

Selph

Lumba‐Brown

et al. 2022

Neurotrauma Reports

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“…During OIF and OEF, total mortality was approximately 15%-20% lower than in the First Gulf War and, of those patients who survived their initial resuscitation, many achieved a good functional outcome. 16,17 While the long-term functional outcomes of the specific 2003 and 2005 patient cohorts treated by this team are largely unknown due to lack of medical record access or confidentiality, approximately half of patients who survived OIF/OEF had a Glasgow Outcome Scale score greater than 3. 18 In comparison with previous conflicts, like the Vietnam War, where blast injuries were also prominent and forward neurosurgical care available, yet without an intensivist, this metric appears to be maintained despite an escalating incidence of CNS injury and complexity of injury patterns.…”

Section: Neuroteam Evolutionmentioning

confidence: 99%

Operation "NeuroTeam": rendering the absolute best care for the most deserving patients under the most difficult conditions

Dang

Boulter

Meister

et al. 2022

Neurosurgical Focus

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The tenets of neurosurgery worldwide, whether in the civilian or military sector, espouse vigilance, the ability to adapt, extreme ownership, and, of course, an innate drive for developing a unique set of technical skills. At a time in history when the complexity of battlefield neurotrauma climaxed coupled with a chronic shortage of military neurosurgeons, modernized solutions were mandated in order to deliver world-class neurological care to our servicemen and servicewomen. Complex blast injuries, as caused by an increased incidence of improvised explosive devices, yielded widespread systemic inflammatory responses with multiorgan damage. In response to these challenges, the "NeuroTeam," originally a unit of two neurosurgeons as deployed during Operation Desert Storm, was redesigned to instead pair a neurosurgeon with a neurointensivist and launched itself during two specialized missions in Operations Iraqi Freedom and Enduring Freedom. Representing a hybridized version of present-day neurocritical care teams, the purpose of this unit was to optimize neurosurgical care by focusing on interdisciplinary collaboration in an Echelon III combat support hospital. The NeuroTeam provided unique workflow capabilities never seen collectively on the battlefield: downrange neurosurgical capability by a board-certified neurological surgeon within 60 minutes from the point of injury paired with a neurocritical care–trained intensivist. This also set the stage for intraoperative telemedicine infrastructure for neurosurgery and optimized the ability to evaluate, triage, and stabilize patients prior to medical evacuation. This novel military partnership ultimately allowed the neurosurgeon to focus on the tenets of the craft and thereby the dynamic needs of the patient first and foremost. Since the success of these missions, the NeuroTeam has evolved into a detachable unit, the "Head and Neck Team," comprising neurosurgeons, otolaryngologists, and ophthalmologists, supported by a postinjury hospital unit, which includes an embedded neurocritical care physician. The creation and evolution of the NeuroTeam, necessitated by a shortage of military neurosurgeons and the dangerous shift in military wartime tactics, best exemplifies multidisciplinary collaboration and military medicine agility. As neurocritical care continues to evolve into a highly complex, distinct specialty, the lessons learned by the NeuroTeam ultimately serve as a reminder for civilian and military physicians alike. Despite the conditions and despite one’s professional ego, patients with highly complex morbid neurological disease deserve expert, multidisciplinary management for survival.

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“…Deep brain stimulation (DBS), in last decades, has been widely used in the routine clinic for the treatment of movement disorders [ 21 – 26 ], epilepsy [ 27 , 28 ], and obsessive-compulsive disorder [ 29 ], and exploratory studies showed that DBS targeting the thalamus (ventral posterolateral (VPL) nucleus or ventral posteromedial (VPM) nucleus), periventricular grey or periaqueductal grey, or anterior cingulate cortex might have a role in pain control [ 30 , 31 ]. Another invasive technique, which showed promising results, is motor cortex stimulation [ 31 – 33 ].…”

Section: Neurostimulation Techniques For Chronic Pain Managementmentioning

confidence: 99%

Focused Ultrasound (FUS) for Chronic Pain Management: Approved and Potential Applications

Biase

Falato

Caminiti

et al. 2021

Neurology Research International

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Chronic pain is one of the leading causes of disability and disease burden worldwide, accounting for a prevalence between 6.9% and 10% in the general population. Pharmacotherapy alone results ineffective in about 70-60% of patients in terms of a satisfactory degree of pain relief. Focused ultrasound is a promising tool for chronic pain management, being approved for thalamotomy in chronic neuropathic pain and for bone metastases-related pain treatment. FUS is a noninvasive technique for neuromodulation and for tissue ablation that can be applied to several tissues. Transcranial FUS (tFUS) can lead to opposite biological effects, depending on stimulation parameters: from reversible neural activity facilitation or suppression (low-intensity, low-frequency ultrasound, LILFUS) to irreversible tissue ablation (high-intensity focused ultrasounds, HIFU). HIFU is approved for thalamotomy in neuropathic pain at the central nervous system level and for the treatment of facet joint osteoarthritis at the peripheral level. Potential applications include HIFU at the spinal cord level for selected cases of refractory chronic neuropathic pain, knee osteoarthritis, sacroiliac joint disease, intervertebral disc nucleolysis, phantom limb, and ablation of peripheral nerves. FUS at nonablative dosage, LILFUS, has potential reversible and tissue-selective effects. FUS applications at nonablative doses currently are at a research stage. The main potential applications include targeted drug and gene delivery through the Blood-Brain Barrier, assessment of pain thresholds and study of pain, and reversible peripheral nerve conduction block. The aim of the present review is to describe the approved and potential applications of the focused ultrasound technology in the field of chronic pain management.

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Two-year mortality and functional outcomes in combat-related penetrating brain injury: battlefield through rehabilitation

Cited by 18 publications

References 27 publications

Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury

Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury

Operation "NeuroTeam": rendering the absolute best care for the most deserving patients under the most difficult conditions

Focused Ultrasound (FUS) for Chronic Pain Management: Approved and Potential Applications

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