title: The evolution of the treatment of traumatic cerebrovascular injury during wartime.
abstract: The approach to traumatic craniocervical vascular injury has evolved significantly in recent years. Conflicts prior to Operations Iraqi and Enduring Freedom were characterized by minimal intervention in the setting of severe penetrating head injury, in large part due to limited far-forward resource availability. Consequently, sequelae of penetrating head injury like traumatic aneurysm formation remained poorly characterized with a paucity of pathophysiological descriptions. The current conflicts have seen dramatic improvements with respect to the management of severe penetrating and closed head injuries. As a result of the rapid field resuscitation and early cranial decompression, patients are surviving longer, which has led to diagnosis and treatment of entities that had previously gone undiagnosed. Therefore, in this paper the authors' purpose is to review their experience with severe traumatic brain injury complicated by injury to the craniocervical vasculature. Historical approaches will be reviewed, and the importance of modern endovascular techniques will be emphasized.
authors.affiliation: Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland 20889, USA. randy.s.bell@us.army.mil
authors.forename: Randy S
authors.initials: RS
authors.lastname: Bell
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Severson
authors.forename: John E
authors.initials: JE
authors.lastname: Wanebo
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crandall
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Armonda
mesh_terms: D001753:Blast Injuries / Q000601:surgery; D001930:Brain Injuries / Q000601:surgery; D020214:Cerebrovascular Trauma / Q000601:surgery*; D005260:Female; D020197:Head Injuries, Penetrating / Q000601:surgery; D006772:Hospitals, Military; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D020196:Trauma, Nervous System / Q000601:surgery*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000601:surgery; D014857:Warfare