{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T13:28:11Z","timestamp":1790515691838,"version":"4.1.0"},"reference-count":52,"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 (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u201318 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2010.3.focus1028","type":"journal-article","created":{"date-parts":[[2011,2,23]],"date-time":"2011-02-23T11:40:52Z","timestamp":1298461252000},"page":"E2","source":"Crossref","is-referenced-by-count":90,"title":["Wartime decompressive craniectomy: technique and lessons learned"],"prefix":"10.3171","volume":"28","author":[{"given":"Brian T.","family":"Ragel","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Klimo","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Wright Patterson Air Force Base, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Connecticut Children's Medical Center, Hartford, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Teff","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brooke Army Medical Center, Fort Sam Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans E.","family":"Bakken","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Madigan Army Medical Center, Fort Lewis, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco A.","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Walter Reed Army Medical Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0280002","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"},{"key":"b2-0280002","series-title":"Airman: Offical Magazine of the United States Air Force","first-page":"4","article-title":"Flying for life","volume":"42","author":"Bates","year":"2008"},{"issue":"4 Suppl","key":"b3-0280002","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":"b4-0280002","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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