Cranioplasty in the deployed environment: experience for host-country nationals
Abstract
Decompressive craniectomy (DC) is the definitive neurosurgical treatment for managing refractory malignant cerebral edema and intracranial hypertension due to combat-related severe traumatic brain injury (TBI). To date, the long-term outcomes and sequelae of this procedure on host-country national (HCN) populations during Operation Iraqi Freedom (Iraq, 2003–2011), Operation Enduring Freedom (Afghanistan, 2001–2014), and Operation Freedom’s Sentinel (Afghanistan, 2015–2021) have not been described, specifically the process and results of delayed custom synthetic cranioplasty. The Joint Trauma System’s Clinical Practice Guidelines (JTS-CPG) for severe head injury counsels surgeons to discard the cranial osseous explant when treating coalition service members. Ongoing political and healthcare system instabilities often preclude opportunities for delayed cranioplasty by host-country assets. Various surgical options (such as hinge craniectomy) are inadequate in the setting of complicated cranial comminution from blast or missile injuries, severe cerebral edema, grossly contaminated wounds, complex polytrauma, and tissue devitalization. Delayed cranioplasty with a custom synthetic implant is a viable but logistically challenging alternative. In this retrospective review, the authors present the first patient series describing delayed custom synthetic cranioplasty in an HCN population performed during active military conflict.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Sep 01, 2022
- Source ID
- 10.3171/2022.7.jns22524
Entities
People
- Jeeho D. Kim
- Justin A. Dye
- Patrick R. Maloney
- Paul N. Porensky
- Peter C. Liacouras
Organizations
- Naval Medical Center San Diego
- University of California, San Francisco
- Walter Reed National Military Medical Center