title: Neurosurgery in Afghanistan during "Operation Enduring Freedom": a 24-month experience.
abstract: OBJECTIVE
  "Operation Enduring Freedom" is the US war effort in Afghanistan in its global war on terror. One US military neurosurgeon is deployed in support of Operation Enduring Freedom to provide care for both battlefield injuries and humanitarian work. Here, the authors analyze a 24-month neurosurgical caseload experience in Afghanistan.
  
  
  METHODS
  Operative logs were analyzed between October 2007 and September 2009. Operative cases were divided into minor procedures (for example, placement of an intracranial pressure monitor) and major procedures (for example, craniotomy) for both battle injuries and humanitarian work. Battle injuries were defined as injuries sustained by soldiers while in the line of duty or injuries to Afghan civilians from weapons of war. Humanitarian work consisted of providing medical care to Afghans.
  
  
  RESULTS
  Six neurosurgeons covering a 24-month period performed 115 minor procedures and 210 major surgical procedures cases. Operations for battlefield injuries included 106 craniotomies, 25 spine surgeries, and 18 miscellaneous surgeries. Humanitarian work included 32 craniotomies (23 for trauma, 3 for tumor, 6 for other reasons, such as cyst fenestration), 27 spine surgeries (12 for degenerative conditions, 9 for trauma, 4 for myelomeningocele closure, and 2 for the treatment of infection), and 2 miscellaneous surgeries.
  
  
  CONCLUSIONS
  Military neurosurgeons have provided surgical care at rates of 71% (149/210) for battlefield injuries and 29% (61/210) for humanitarian work. Of the operations for battle trauma, 50% (106/210) were cranial and 11% (25/210) spinal surgeries. Fifteen percent (32/210) and 13% (27/210) of operations were for humanitarian cranial and spine procedures, respectively. Overall, military neurosurgeons in Afghanistan are performing life-saving cranial and spine stabilization procedures for battlefield trauma and acting as general neurosurgeons for the Afghan community.
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA. brian.ragel@gmail.com
authors.forename: Brian T
authors.initials: BT
authors.lastname: Ragel
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kowalski
authors.forename: Randall R
authors.initials: RR
authors.lastname: McCafferty
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Liu
authors.forename: Derek A
authors.initials: DA
authors.lastname: Taggard
authors.forename: David
authors.initials: D
authors.lastname: Garrett
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000533:Altruism; D056424:Decompressive Craniectomy / Q000379:methods; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D009493:Neurosurgery / Q000379:methods* / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery