Craniotomies at an overseas military treatment facility: Maintaining readiness for the unit and the surgeon

• Published in: Clinical neurology and neurosurgery 2023-07, Vol.230, p.107742-107742, Article 107742
• Main Authors: Woodle, Samuel, Ravindra, Vijay M., Dewar, Callum, Yokoi, Hana, Meister, Melissa, Curry, Brian, Miller, Charles, Ikeda, Daniel S.
• Format: Article
• Language: English
• Subjects: Active-duty military; Arteriovenous malformation; Brain cancer; Brain tumor; Craniotomy; Head trauma; Hospitals; Humans; Intensive care; Military Personnel; Neurology; Neurosurgery; Neurosurgical Procedures - methods; Pandemics; Pathology; Patient safety; Patients; Postoperative period; Retrospective Studies; Surgeons; Surgery
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2023.107742

Craniotomy and craniectomy are common neurosurgical procedures with wide applications in both civilian and military practice. Skill maintenance for these procedures is required for military providers in the event they are called to support forward deployed service members suffering from combat and non-combat injuries. The presents investigation details the performance of such procedures at a small, overseas military treatment facility (MTF). A retrospective review of craniotomy procedures performed at an overseas military treatment facility (MTF) over a 2-year period (2019–2021) was performed. Patient and procedural data were collected for all elective and emergent craniotomies including surgical indications, outcomes, complications, military rank, and impact on duty status and tour curtailment. A total of 11 patients underwent a craniotomy or craniectomy procedure with an average follow-up of 496.8 days (range 103–797). Seven of the 11 patients were able to undergo surgery, recovery, and convalesce without transfer to a larger hospital network or MTF. Of the 6 patients that were active duty (AD), one returned to full duty while three separated and two remain in partial duty status at latest follow-up. There were four complications in four patients with one death. In this series, we demonstrate that cranial neurosurgical procedures can be performed safely and effectively while at an overseas MTF. There are potential benefits to the AD service members, their unit, and family as well as to the hospital treatment team and surgeon as this represents a clinical capability requisite to maintain trauma readiness for future conflicts. •Performing craniotomies is essential to maintain surgeon readiness in the military.•Healthcare received while overseas allows for unit readiness rather than transfer to US.•Historically, complex surgery like craniotomy was deferred to large hospitals.•The authors demonstrate the feasibility and safety of craniotomy performed overseas.