{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:58:35Z","timestamp":1788440315950,"version":"build-2803163510"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2010,5]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Decompressive craniectomy has defined this era of damage-control wartime neurosurgery. Injuries that in previous conflicts were treated in an expectant manner are now aggressively decompressed at the far-forward Combat Support Hospital and transferred to Walter Reed Army Medical Center (WRAMC) and National Naval Medical Center (NNMC) in Bethesda for definitive care. The purpose of this paper is to examine the baseline characteristics of those injured warriors who received decompressive craniectomies. The importance of this procedure will be emphasized and guidance provided to current and future neurosurgeons deployed in theater.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors retrospectively searched a database for all soldiers injured in Operations Iraqi Freedom and Enduring Freedom between April 2003 and October 2008 at WRAMC and NNMC. Criteria for inclusion in this study included either a closed or penetrating head injury suffered during combat operations in either Iraq or Afghanistan with subsequent neurosurgical evaluation at NNMC or WRAMC. Exclusion criteria included all cases in which primary demographic data could not be verified. Primary outcome data included the type and mechanism of injury, Glasgow Coma Scale (GCS) score and injury severity score (ISS) at admission, and Glasgow Outcome Scale (GOS) score at discharge, 6 months, and 1\u20132 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four hundred eight patients presented with head injury during the study period. In this population, a total of 188 decompressive craniectomies were performed (154 for penetrating head injury, 22 for closed head injury, and 12 for unknown injury mechanism). Patients who underwent decompressive craniectomies in the combat theater had significantly lower initial GCS scores (7.7 \u00b1 4.2 vs 10.8 \u00b1 4.0, p &lt; 0.05) and higher ISSs (32.5 \u00b1 9.4 vs 26.8 \u00b1 11.8, p &lt; 0.05) than those who did not. When comparing the GOS scores at hospital discharge, 6 months, and 1\u20132 years after discharge, those receiving decompressive craniectomies had significantly lower scores (3.0 \u00b1 0.9 vs 3.7 \u00b1 0.9, 3.5 \u00b1 1.2 vs 4.0 \u00b1 1.0, and 3.7 \u00b1 1.2 vs 4.4 \u00b1 0.9, respectively) than those who did not undergo decompressive craniectomies. That said, intragroup analysis indicated consistent improvement for those with craniectomy with time, allowing them, on average, to participate in and improve from rehabilitation (p &lt; 0.05). Overall, 83% of those for whom follow-up data are available achieved a 1-year GOS score of greater than 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study of the provision of early decompressive craniectomy in a military population that sustained severe penetrating and closed head injuries represents one of the largest to date in both the civilian and military literature. The findings suggest that patients who undergo decompressive craniectomy had worse injuries than those receiving craniotomy and, while not achieving the same outcomes as those with a lesser injury, did improve with time. The authors recommend hemicraniectomy for damage control to protect patients from the effects of brain swelling during the long overseas transport to their definitive care, and it should be conducted with foresight concerning future complications and reconstructive surgical procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2010.2.focus1022","type":"journal-article","created":{"date-parts":[[2011,2,23]],"date-time":"2011-02-23T11:40:52Z","timestamp":1298461252000},"page":"E1","source":"Crossref","is-referenced-by-count":118,"title":["Early decompressive craniectomy for severe penetrating and closed head injury during wartime"],"prefix":"10.3171","volume":"28","author":[{"given":"Randy S.","family":"Bell","sequence":"first","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey M.","family":"Mossop","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"National Capital Consortium Neurosurgery Program, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Dirks","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"National Capital Consortium Neurosurgery Program, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick L.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"National Capital Consortium Neurosurgery Program, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Mulligan","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ecker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Neal","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodoro","family":"Tigno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed Army Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco A.","family":"Armonda","sequence":"additional","affiliation":[{"name":"Uniformed Services University of Health Sciences;"},{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland;"},{"name":"Department of Neurosurgery, Walter Reed Army Medical Center; and"},{"name":"National Capital Consortium Neurosurgery Program, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0280001","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"469","DOI":"10.3171\/jns.2006.104.4.469","article-title":"Outcome following decompressive craniectomy for malignant swelling due to severe head injury","volume":"104","author":"Aarabi","year":"2006"},{"key":"b2-0280001","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/00006123-199803000-00014","article-title":"Central nervous system infections after military missile head wounds","volume":"42","author":"Aarabi","year":"1998"},{"key":"b3-0280001","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/0090-3019(92)90109-Z","article-title":"Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank","volume":"38","author":"Aldrich","year":"1992"},{"key":"b4-0280001","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1227\/01.NEU.0000249190.46033.94","article-title":"Wartime traumatic cerebral vasospasm: recent review of combat casualties","volume":"59","author":"Armonda","year":"2006"},{"issue":"4 Suppl","key":"b5-0280001","series-title":"J Trauma","first-page":"S104","article-title":"Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system","volume":"66","author":"Bell","year":"2009"},{"key":"b6-0280001","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1227\/01.NEU.0000361285.50218.A8","article-title":"Wartime traumatic aneurysms: acute presentation, diagnosis, and multimodal treatment of 64 craniocervical arterial injuries","volume":"66","author":"Bell","year":"2010"},{"key":"b7-0280001","series-title":"Mil Med","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1093\/milmed\/149.2.55","article-title":"The causes of death in conventional land warfare: implications for combat casualty care research","volume":"149","author":"Bellamy","year":"1984"},{"key":"b8-0280001","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3171\/jns.1990.72.1.0015","article-title":"Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982\u20131985. 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