Neurosurgery in Afghanistan during “Operation Enduring Freedom”: a 24-month experience

2010 ◽  
Vol 28 (5) ◽  
pp. E8 ◽  
Author(s):  
Brian T. Ragel ◽  
Paul Klimo ◽  
Robert J. Kowalski ◽  
Randall R. McCafferty ◽  
Jeannette M. Liu ◽  
...  
Keyword(s):  
Surgical Care ◽  
Operation Enduring Freedom ◽  
Pressure Monitor ◽  
Global War On Terror ◽  
Spine Stabilization ◽  
War Effort ◽  
Global War ◽  
Battlefield Injuries ◽  
Battle Injuries ◽  
Humanitarian Work

Object “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.

scholarly journals Elective neurosurgical humanitarian care in a deployed setting

2018 ◽  
Vol 45 (6) ◽  
pp. E8 ◽  
Author(s):  
Jonathan A. Forbes
Keyword(s):  
Surgical Care ◽  
Residual Tumor ◽  
Metastatic Lesion ◽  
Neurosurgical Procedures ◽  
Radiological Data ◽  
The Us ◽  
War Effort ◽  
Air Force Base ◽  
Battlefield Injuries ◽  
Age Range

OBJECTIVEActive-duty neurosurgical coverage has been provided at Bagram Air Force Base in Afghanistan since 2007. Early operative logs were reflective of a large number of surgical procedures performed to treat battlefield injuries. However, with maturation of the war effort, the number of operations for battlefield injuries has decreased with time. Consequently, procedures performed for elective neurosurgical humanitarian care (NHC) increased in number and complexity prior to closure of the Korean Hospital in 2015, which resulted in effective termination of NHC at Bagram. Monthly neurosurgical caseloads for deployed personnel have dropped precipitously since this time, renewing a debate as to whether the benefits of providing elective NHC in Afghanistan outweigh the costs of such a strategy. To date, there is a paucity of information in the literature discussing the overall context of such a determination.METHODSThe author retrospectively reviewed his personal database of all patients who underwent neurosurgical procedures at Bagram during his deployment there from April 17 to October 29, 2014. Standardized clinical parameters had been recorded in the ABNS NeuroLog system. All cases of nonelective surgical care for battlefield injuries were identified and excluded. Records of all other procedures, which represented elective NHC delivered during this period, were accessed to extract salient clinical and radiological data.RESULTSDuring the 6-month deployment, 49 patients (29 male and 20 female, age range 18 months to 63 years) were treated by the author in elective NHC. Procedures were performed for spinal degenerative disease (n = 28), cranial tumors (n = 11), pediatric conditions (n = 6), Pott’s disease (n = 2), peripheral nerve impingement (n = 1), and adult hydrocephalus (n = 1). The duration of follow-up ranged from 3 to 23 weeks. Complications referable to surgery included asymptomatic, unilateral lumbar screw fracture detected 3 months postoperatively and treated with revision of hardware (n = 1); wound infection requiring cranial flap explantation and staged cranioplasty (n = 1); and unanticipated return to the operating room for resection of residual tumor in a patient with a solitary metastatic lesion involving the mesial temporal lobe/ambient cistern (n = 1). There were no instances of postoperative neurological decline.CONCLUSIONSElective NHC can be safely and effectively implemented in the deployed setting. Benefits of a military strategy that supports humanitarian care include strengthening of the bond between the US/Afghan military communities and the local civilian population as well as maintenance of skills of the neurosurgical team during the sometimes-lengthy intervals between cases in which emergent neurosurgical care is provided for treatment of battlefield injuries.

Protecting the home front: The 10-year global war on terror and our military families

2013 ◽  
Author(s):  
Candice A. Alfano ◽  
Jessica Balderas ◽  
Simon Lau ◽  
Brian E. Bunnell ◽  
Deborah C. Beidel
Keyword(s):  
War On Terror ◽  
Military Families ◽  
Home Front ◽  
Global War On Terror ◽  
Global War

The Global War on Terror.

2015 ◽  
Vol 20 (2) ◽  
pp. 133-136 ◽  
Author(s):  
Abigail B. Calkin
Keyword(s):  
War On Terror ◽  
Global War On Terror ◽  
Global War

War and Terror

2017 ◽  
Author(s):  
Avinash Paliwal
Keyword(s):  
War On Terror ◽  
Global War On Terror ◽  
Military Action ◽  
Global Trend ◽  
The Us ◽  
The World ◽  
Global War

The Taliban’s destruction of the Bamiyan Buddha in March 2001 outraged India (and the world). It killed any scope for conciliation with the Taliban. In this context, the US decision to take military action in Afghanistan after the 9/11 attacks was welcomed by many in India. However, Washington’s decision to undertake such action without UN approval (which came only in December 2001) sparked another round of debate between the partisans and the conciliators. As this chapter shows, the former were enthusiastic about supporting the US in its global war on terror, but the latter advocated caution given Washington’s willingness to partner with Islamabad. Despite the global trend to ‘fight terrorism’, the conciliators were successful in steering India away from getting involved in Afghanistan militarily.

Deterrence and Democracy

2018 ◽  
Author(s):  
Richard A. Falkenrath
Keyword(s):  
War On Terror ◽  
Terrorist Attacks ◽  
Global War On Terror ◽  
Counter Terrorism ◽  
Liberal Democratic ◽  
The Us ◽  
Democratic Societies ◽  
Global War ◽  
Taking Action ◽  
The Given

This chapter examines strategy and deterrence and traces the shift from deterrence by ‘punishment’ to deterrence by ‘denial’ in Washington’s conduct of the Global War on Terror. The former rested on an assumption that the consequences of an action would serve as deterrents. The latter may carry messages of possible consequences, but these are delivered by taking action that removes the capabilities available to opponents – in the given context, the Islamist terrorists challenging the US. Both approaches rest on credibility, but are more complex in the realm of counter-terrorism, where the US authorities have no obvious ‘return to sender’ address and threats to punish have questionable credibility. In this context, denial offers a more realistic way of preventing terrorist attacks. Yet, the advanced means available to the US are deeply ethically problematic in liberal democratic societies. However, there would likely be even bigger questions if governments failed to act.

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