Wartime decompressive craniectomy: technique and lessons learned

Ragel, Brian T.; Klimo, Paul; Martin, Jonathan E.; Teff, Richard J.; Bakken, Hans; Armonda, Rocco A.

doi:10.3171/2010.3.focus1028

Cited by 96 publications

(82 citation statements)

References 23 publications

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“…It begins at the widow's peak, continues posteriorly along the midline to the inion, it then turns sharply to the ear parallel to a line extending from the inion to the root of the zygoma [66]. The incision should skirt the superior and anterior portions of the ear as closely as possible and extend 1 cm below the root of the zygoma.…”

Section: Large Reverse Question Mark Frontotemporoparietal Incisionmentioning

confidence: 99%

“…Kjellberg type In this, is made a standard bicoronal incision, beginning 1-2cm anterior to the tragus, going superiorly behind the coronal suture until finding the opposite root of the zygoma, also ending 2cm anterior to the tragus [66]. The flap resulting is reflected anteriorly and inferiorly exposing the frontal and anterior temporal lobes [67].…”

Section: Lg Kempe Modified Incision or Midline Sagittal Incision Wimentioning

confidence: 99%

“…The scalp is incised in the midline from the widow's peak to the inion, after this, is created a limb to the incision, forming the «T-bar» from 1-2cm anterior to the tragus, extending superiorly, 1cm behind the coronal suture until find the midline sagittal incision [65][66][67] Skin incisions for bilateral decompressive craniectomies Bilateral craniectomies are especially useful in cases of bilateral frontal contusions or generalized cerebral edema without focal lesion [65]. Can be performed in two ways:…”

Section: Lg Kempe Modified Incision or Midline Sagittal Incision Wimentioning

confidence: 99%

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Decompressive craniectomy in traumatic brain injury: Quo Vadis?

et al. 2014

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Intracranial hypertension is the leading cause of mortality in patients with cranial injury. Currently the traumatic brain injury is a public health problem worldwide. Decompressive craniectomy emerges as a treatment strategy for patients with refractory intracranial hypertension. The completed surgery requires careful surgical technique and exquisite. We present a review of the literature about the technique.

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Section: Large Reverse Question Mark Frontotemporoparietal Incisionmentioning

confidence: 99%

Section: Lg Kempe Modified Incision or Midline Sagittal Incision Wimentioning

confidence: 99%

Section: Lg Kempe Modified Incision or Midline Sagittal Incision Wimentioning

confidence: 99%

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Decompressive craniectomy in traumatic brain injury: Quo Vadis?

et al. 2014

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“…Currently, immediate treatment includes aggressive decompressive craniectomy, conservative brain debridement, and a watertight dural repair. 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 increased number of traumatic blast injuries caused by improvised explosive devices has contributed to a paradigm shift, with an emerging assertiveness and willingness of wartime surgeons to perform early decompressive craniectomies in severely injured patients. 10,51 This trend of early decompression leading to increased survival has, in turn, unmasked growing numbers of traumatic cerebrovascular injuries.…”

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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Wartime decompressive craniectomy: technique and lessons learned

Cited by 96 publications

References 23 publications

Decompressive craniectomy in traumatic brain injury: Quo Vadis?

Decompressive craniectomy in traumatic brain injury: Quo Vadis?

The history of military cranioplasty

The influence of war on the development of neurosurgery

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