Early decompressive craniectomy for blast and penetrating brain injury in war: Lessons for civilian surgeons

Bomb blast causes severe multiple trauma and distinctive patterns of head and neck injury. Brain swelling, hemorrhage, and penetrating metal and bone fragments with intracranial air are typical, resulting in severe intracranial hypertension. Decompressive craniectomy has become a mainstay of treatment for blast and missile penetrating injuries of the brain occurring in modern warfare. The clinical management and the surgical techniques for these injuries are directly transferable to the management of civilians injured by bomb blast during terrorist attacks in countries where wars are not being fought. We therefore strongly recommend that civilian neurosurgeons become familiar with the resuscitation, assessment, investigation, and surgery required to treat these injuries.