{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:33:13Z","timestamp":1789147993266,"version":"build-2803163510"},"reference-count":10,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>There are no published long-term data for patients with penetrating head injury treated with bilateral supratentorial craniectomy, or supra- and infratentorial craniectomy. The authors report their experience with 33 patients treated with bilateral or bicompartmental craniectomy from the ongoing conflicts in Iraq and Afghanistan.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>An exploratory analysis of Glasgow Outcome Scale (GOS) scores at 6 months in 33 patients was performed. Follow-up lasting a median of more than 2 years was performed in 30 (91%) of these patients. The association of GOS score with categorical variables was explored using the Wilcoxon rank-sum test or Kruskal-Wallis analysis of variance. The Spearman correlation coefficient was used for ordinal\/continuous data. To provide a clinically meaningful format to present GOS scores with categorical variables, patients with GOS scores of 1\u20133 were categorized as having a poor outcome and those with scores of 4 and 5 as having a good outcome. This analysis does not include the patients who died in theater or in Germany who underwent bilateral decompressive craniectomy because those figures have not been released due to security concerns.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>All patients were men with a median age of 24 years (range 19\u201346 years) and a median initial Glasgow Coma Scale (GCS) score of 5 (range 3\u201314). At 6 months, 9 characteristics were statistically significant: focus of the initial injury, systemic infection, initial GCS score, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, GCS score on dismissal from the medical center, Injury Severity Score, and patients with cerebrovascular injury. Six factors were significant at long-term follow-up: focus of initial injury, systemic infection, initial GCS score excluding patients with a GCS score of 3, GCS score on arrival to the US, and GCS score on dismissal from the medical center. At long-term follow-up, 7 (23%) of 30 patients had died, 5 (17%) of 30 had a GOS score of 2 or 3, and 18 (60%) of 30 had a GOS score of 4 or 5.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this selected group of patients who underwent bilateral or bicompartmental craniectomy, 60% are independent at long-term follow-up. Patients with bifrontal injury fared best. Systemic infection and cerebrovascular injury corresponded with a worse outcome.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.2.jns101490","type":"journal-article","created":{"date-parts":[[2011,3,25]],"date-time":"2011-03-25T14:10:48Z","timestamp":1301062248000},"page":"124-129","source":"Crossref","is-referenced-by-count":36,"title":["Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy"],"prefix":"10.3171","volume":"115","author":[{"given":"Robert D.","family":"Ecker","sequence":"first","affiliation":[{"name":"Maine Medical Partners Neurosurgery & Spine, Scarborough, Maine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa P.","family":"Mulligan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dirks","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy S.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryl A.","family":"Severson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin S.","family":"Howard","sequence":"additional","affiliation":[{"name":"Clinical Investigation, Walter Reed Army Medical Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco A.","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101490","series-title":"Neurosurgery","first-page":"1215","article-title":"Wartime traumatic cerebral vasospasm: recent review of combat casualties","volume":"59","author":"Armonda","year":"2006"},{"key":"b2-jns101490","series-title":"Neurosurgery","first-page":"66","article-title":"Wartime traumatic aneurysms: acute presentation, diagnosis, and multimodal treatment of 64 craniocervical arterial injuries","volume":"66","author":"Bell","year":"2010"},{"key":"b3-jns101490","series-title":"Lancet Neurol","first-page":"326","article-title":"Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial","volume":"8","author":"Hofmeijer","year":"2009"},{"key":"b4-jns101490","series-title":"Stroke","first-page":"2518","article-title":"Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial","volume":"38","author":"J\u00fcttler","year":"2007"},{"key":"b5-jns101490","series-title":"J Neurosurg","first-page":"488","article-title":"Bifrontal decompressive craniotomy for massive cerebral edema","volume":"34","author":"Kjellberg","year":"1971"},{"key":"b6-jns101490","series-title":"Neurosurgery","first-page":"84","article-title":"Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema","volume":"41","author":"Polin","year":"1997"},{"key":"b7-jns101490","series-title":"J Neurol Neurosurg Psychiatry","first-page":"106","article-title":"Hemicraniectomy in the treatment of acute subdural haematoma","volume":"34","author":"Ransohoff","year":"1971"},{"key":"b8-jns101490","series-title":"Curr Treat Options Neurol","first-page":"113","article-title":"Decompressive hemicraniectomy for malignant hemispheric infarction","volume":"11","author":"Vahedi","year":"2009"},{"key":"b9-jns101490","series-title":"Lancet Neurol","first-page":"215","article-title":"Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials","volume":"6","author":"Vahedi","year":"2007"},{"key":"b10-jns101490","series-title":"J Neurosurg","first-page":"429","article-title":"Bifrontal decompressive craniectomy in the management of head trauma","volume":"42","author":"Venes","year":"1975"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p124.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p124.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p124.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T03:08:45Z","timestamp":1679886525000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p124.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":10,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2011.2.jns101490","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]}}}