Position of neurosurgery in deployment medicine

The rigid character of the skull provides protection for the brain; in trauma, however, concomitant brain swelling, contusion, and possible hematoma create increased intracranial pressure and likely further injury to brain and components. Rapid alleviation of such pressure reduces mortality and morbidity. Standard of care in neurosurgery mandates complex diagnostic and surgical facilities. Such is not available at forward echelons of deployed military medical units. The author compares the austerity of forward-located neurosurgery against that farther to the rear and recommends the former on the merits of the major reduction of time between injury and surgery.