Wartime decompressive craniectomy: Technique and lessons learned

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

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Object. Decompressive craniectomy (DC) with dural expansion is a life-saving neurosurgical procedure performed for recalcitrant intracranial hypertension due to trauma, stroke, and a multitude of other etiologies. Illustratively, we describe technique and lessons learned using DC for battlefield trauma. Methods. Neurosurgical operative logs from service (October 2007 to September 2009) in Afghanistan that detail DC cases for trauma were analyzed. Illustrative examples of frontotemporoparietal and bifrontal DC that depict battlefield experience performing these procedures are presented with attention drawn to the L.G. Kempe hemispherectomy incision, brainstem decompression techniques, and dural onlay substitutes. Results. Ninety craniotomies were performed for trauma over the time period analyzed. Of these, 28 (31%) were DCs. Of the 28 DCs, 24 (86%) were frontotemporoparietal DCs, 7 (25%) were bifrontal DCs, and 2 (7%) were suboccipital DCs. Decompressive craniectomies were performed for 19 penetrating head injuries (13 gunshot wounds and 6 explosions) and 9 severe closed head injuries (6 war-related explosions and 3 others). Conclusions. Thirty-one percent of craniotomies performed for trauma were DCs. Battlefield neurosurgeons use DC to allow for safe transfer of neurologically ill patients to tertiary military hospitals, which can be located 8-18 hours from a war zone. The authors recommend the L.G. Kempe incision for blood supply preservation, large craniectomies to prevent brain strangulation over bone edges, minimal brain debridement, adequate brainstem decompression, and dural onlay substitutes for dural closure.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalNeurosurgical Focus
Volume28
Issue number5
DOIs
StatePublished - May 1 2010
Externally publishedYes

Fingerprint

Decompressive Craniectomy
Wounds and Injuries
Inlays
Explosions
Craniotomy
Decompression
Brain Stem
Penetrating Head Injuries
Blood Preservation
Hemispherectomy
Neurosurgical Procedures
Closed Head Injuries
Afghanistan
Military Hospitals
Gunshot Wounds
Intracranial Hypertension
Brain
Debridement
Tertiary Care Centers
Stroke

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Ragel, B. T., Klimo, P., Martin, J. E., Teff, R. J., Bakken, H. E., & Armonda, R. A. (2010). Wartime decompressive craniectomy: Technique and lessons learned. Neurosurgical Focus, 28(5), 1-10. https://doi.org/10.3171/2010.3.FOCUS1028

Wartime decompressive craniectomy : Technique and lessons learned. / Ragel, Brian T.; Klimo, Paul; Martin, Jonathan E.; Teff, Richard J.; Bakken, Hans E.; Armonda, Rocco A.

In: Neurosurgical Focus, Vol. 28, No. 5, 01.05.2010, p. 1-10.

Research output: Contribution to journalArticle

Ragel, BT, Klimo, P, Martin, JE, Teff, RJ, Bakken, HE & Armonda, RA 2010, 'Wartime decompressive craniectomy: Technique and lessons learned', Neurosurgical Focus, vol. 28, no. 5, pp. 1-10. https://doi.org/10.3171/2010.3.FOCUS1028
Ragel, Brian T. ; Klimo, Paul ; Martin, Jonathan E. ; Teff, Richard J. ; Bakken, Hans E. ; Armonda, Rocco A. / Wartime decompressive craniectomy : Technique and lessons learned. In: Neurosurgical Focus. 2010 ; Vol. 28, No. 5. pp. 1-10.
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