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Updated: Jun 12, 2026

Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
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Wartime decompressive craniectomy: technique and lessons learned.

Brian T Ragel1, Paul Klimo, Jonathan E Martin

  • 1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA. brian.ragel@gmail.com

Neurosurgical Focus
|June 24, 2010
PubMed
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This summary is machine-generated.

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Decompressive craniectomy (DC) is vital for battlefield head trauma. This neurosurgical technique aids patient transfer from combat zones to hospitals, improving outcomes.

Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Critical Care

Background:

  • Decompressive craniectomy (DC) is a critical neurosurgical intervention for managing severe intracranial hypertension.
  • It is employed across various etiologies including traumatic brain injury, stroke, and other neurological emergencies.
  • Battlefield neurosurgery presents unique challenges requiring specialized techniques for managing complex trauma.

Purpose of the Study:

  • To describe the technique and lessons learned from performing decompressive craniectomy (DC) for battlefield trauma.
  • To analyze the utilization and outcomes of DC in a deployed military surgical setting.
  • To highlight specific technical considerations for DC in the context of war injuries.

Main Methods:

  • Analysis of neurosurgical operative logs detailing DC cases for trauma sustained in Afghanistan (October 2007-September 2009).

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  • Presentation of illustrative examples of frontotemporoparietal and bifrontal DC.
  • Focus on specific techniques including the L.G. Kempe hemispherectomy incision, brainstem decompression, and use of dural onlay substitutes.

    • Main Results:

    • Ninety craniotomies were performed for trauma, with 28 (31%) being DCs.
    • Frontotemporoparietal DCs constituted the majority (86%), followed by bifrontal (25%) and suboccipital (7%).
    • DCs were performed for 19 penetrating head injuries and 9 severe closed head injuries, predominantly from explosions and gunshot wounds.

    Conclusions:

    • Decompressive craniectomy (DC) represented 31% of trauma-related craniotomies in this series.
    • DC facilitates safe evacuation of critically ill neurosurgical patients from combat zones to tertiary care facilities.
    • Recommendations include the L.G. Kempe incision, large craniectomies, minimal debridement, adequate brainstem decompression, and dural substitutes for closure.