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  • Military Neurosurgery: What Have We Learned After More Than 15 Years of War

    Final Number:

    Chris J. Neal MD; Sarah Cantrell MLIS; Jason H Boulter MD; Randy Scott Bell MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: As of March 2013, the Unites States military had already been involved in fighting the Taliban in Afghanistan under Operation Enduring Freedom (OEF) for almost one and a half years. But the start of Operation Iraqi Freedom (OIF) dramatically changed the scope of neurotrauma seen by the military medical community. As we reflect on the last 15 years since "shock and awe" started OIF, it is important to understand the lessons learned from these conflicts and how to apply these in the future.

    Methods: A military neurosurgery bibliography was created by running two search strategies in PubMed and Embase. The results were then individually reviewed for applicability and duplicates and subsequently categorized. Articles from conflicts since 9/11/01 were identified and reviewed for general themes.

    Results: Over 1200 articles were initially identified. Of these only 327 were related to military neurosurgery. 116 of them were related to military neurosurgery since 9/11/01. A review of these articles resulted in the following areas of interest: decompressive craniectomy after severe TBI and subsequent treatment issues, spine surgery, and aeromedical transport. These were further explored to determine specific lessons learned from each topic as well as to identify areas for further research and improvement. Additionally, evaluating military neurosurgery training in light of what these lessons have taught us.

    Conclusions: After more than 15 years of conflict, military neurosurgery has contributed significantly to the literature and has provided the foundation to extract valuable lessons that need to be utilized to improve our current care model and to shape the training for the next generation of military neurosurgeons. While aimed at the military neurosurgeon, these lessons are often applicable to anyone taking care of neurotrauma.

    Patient Care: Understanding and applying these lessons learned shapes our practice in how we treat injured services members and train the next generation of military neurosurgeons. Furthermore, it identifies knowledge gaps that will be the focus of future research.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the unique aspects of military neurosurgery. 2) Discuss the role of decompressive craniectomy in severe TBI in a combat hospital setting. 3) Be able to describe the challenges of treating spine and spinal cord injury in a downrange environment. 4) Appreciate the role aeromedical evacuation plays in the treatment of combat casualties. 5) Describe the importance of incorporating the unique aspects of military neurosurgery into training.


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