The Afghanistan Surge saw NATO troops working with their Afghan partners to remove Taliban governance and replace it with a more democratic model. As part of this endeavor, medical support for both trauma and humanitarian cases was needed.

In a retrospective review of operative experience from a neurosurgeon from November 2010 to April 2011.

63 cases were performed on 20 NATO and 43 Afghan patients. Combat-related neurotrauma represented 73% (46/63) of cases and humanitarian cases represented the remainder. The most common diseases among humanitarian cases were benign tumors (29%, 5/17), cranioplasty (23%, 4/17), obstructive hydrocephalus (11%, 2/17), nonobstructive hydrocephalus (11%, 2/17), hemifacial spasm (11%, 2/17), and cerebral angiography (11%, 2/17). There was 1 death from ventriculitis for a complication rate of 6%.

In select well-nourished, patients with minimal risk of needing tracheostomy, humanitarian neurosurgery can be safely performed in theater with a complication rate (6%) no worse than patients operated on in the United States 1).

Combat-related neurotrauma represented 73% (46/63) of cases, the majority of which were as a result of nonpenetrating injury (89%, 41/46). The most common area injured was the spine, accounting for 51% (21/41) of all nonpenetrating injuries. The majority of spine injuries occurred in NATO patients (61%, 13/21). The second most common area of nonpenetrating injury was the brain, occurring in 48% (20/41) of cases, primarily in Afghan troops (80%, 16/20). Overall, there were 2 deaths and 2 reoperations, for a complication rate of 8%.

Future combat missions relying on mounted patrols may benefit from an emphasis on the use of vehicle safety equipment to decrease the incidence of brain injury, along with in theater neurosurgery care offering spine stabilization 2).

In 2009, during the war in Afghanistan, the increasing number of head injury led to the deployment of a military neurosurgeon at the Kabul International Airport (KaIA) medical treatment facility, in March 2010. The main goal of this study was to depict the neurosurgical activity in this centre and to analyse its different aspects.

Three hundred and seventy-three interventions performed by the neurosurgeon deployed were reported for 373 surgeries, in 335 patients, representing 10.6 % of the overall surgical activity of the centre. Among the 69 interventions performed on soldiers, 57 surgeries were undertaken in emergency (82.6 %), while 12 were elective procedures (17.4 %). On the other hand, 289 surgeries were performed in civilian Afghans, with 126 emergency procedures in (43.6 %), against 163 elective interventions (56.4 %). Among the 44.5 % (n = 149) of the traumatic casualties, cerebral lesions represented 28.7 % (n = 96) and spinal lesions 12.4 % (n = 42). Ninety patients had multiple injuries. Additionally, patients without trauma accounted for 55.5 % (n = 186) of the overall population. Thus, 49 % (n = 164) were operated on for non-traumatic lesion of the spine. These were mostly civilian Afghans treated under medical aid to the population (90.2 %, n = 148/164).

The military neurosurgeon had two roles in KaIA: both to support the armed forces and to manage medical aid to the civilian population. This study gives food for thought on the neurosurgical needs in modern warfare, and on the skills required for the military neurosurgeon 3).

41 children (1 to 18 years; mean, 8.5 years; median, 9 years), 28 (68.2%) with penetrating injuries. Blast injury (13 patients) and burns (nine) were the most common mechanisms. At arrival 19 (46.3%) underwent endotracheal intubation, four (9.8%) had no palpable blood pressure, 10.6 per cent (four of 38) a Glasgow coma score of 5 or less, 30.6 per cent (11 of 36) base deficits of 6 or less, and 41.7 per cent (15 of 36) hematocrit 30 or less. Red cells were given in 14 (34.1%) and plasma in 11 (26.8%). Of 32 total nonburn patients, 12 (37.5%) had multiple system injuries. Three-fourths of injuries were severe (75.8% [47 of 62] Abbreviated Injury Score 3 or greater). Thirty-two patients (78.0%) required major operations: burn and wound care, orthopedic, chest, abdominal, vascular, and neurosurgical. Second operations were performed in 16 (39.0%), most often burn and orthopedic procedures. Six died (14.6%), 13 were transferred to other hospitals (31.7%), and 20 were discharged to home (48.8%; two not noted). Broad experience in operative trauma care, pediatric resuscitation, and critical care is a priority for military surgeons 4).

Steele JJ 3rd. Single Neurosurgeon Operative Experience at Craig Joint Theater Hospital During the Afghanistan Surge (November 2010 to April 2011), Part II: Humanitarian Cases. Mil Med. 2017 Jan;182(1):e1614-e1618. doi: 10.7205/MILMED-D-15-00590. PubMed PMID: 28051982.
Steele JJ 3rd. Single Neurosurgeon Operative Experience at Craig Joint Theater Hospital During the Afghanistan Surge (November 2010 to April 2011), Part I: Neurotrauma Cases. Mil Med. 2017 Jan;182(1):e1610-e1613. doi: 10.7205/MILMED-D-15-00593. PubMed PMID: 28051981.
Joubert C, Dulou R, Delmas JM, Desse N, Fouet M, Dagain A. Military neurosurgery in operation: experience in the French role-3 medical treatment facility of Kabul. Acta Neurochir (Wien). 2016 Aug;158(8):1453-63. doi: 10.1007/s00701-016-2843-z. Epub 2016 Jun 10. PubMed PMID: 27287215.
Wilson KL, Schenarts PJ, Bacchetta MD, Rai PR, Nakayama DK. Pediatric trauma experience in a combat support hospital in eastern Afghanistan over 10 months, 2010 to 2011. Am Surg. 2013 Mar;79(3):257-60. PubMed PMID: 23461950.
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