Not Just New Technologies, New Techniques

At the start of the Iraq war in 2003 a group of eight American neurologists and neurosurgeons took a bold new approach to the emergency treatment of traumatic brain injuries (TBIs) sustained by soldiers in the field. Previous conflicts have shown that fewer than 10% of soldiers survived serious TBIs. Of those, less than 5% were able to resume a life without assistance. The prevalent use of IEDs by the insurgents in Iraq and Afghanistan has made the treatment of TBIs one of military medicine's most daunting challenges. Dr. Rocco Armondo was the commander of the Army's 207th Neurosurgery Team, the team that operated out of the 28th Combat Support Hospital near Fallujah. Dr. Armondo and his team developed a technique whereby they opened the skull to allow for the normal swelling of the brain to fully take its course (thus their macabre sobriquet "Skull Crackers").


They had determined that it was the increased pressure exerted by the traumatized and swollen brain tissue that ultimately resulted in the greatest incidence of coma and the most serious and long-term effects. After opening the skull, balloon stents are strategically administered to keep vessels open that have been constricted by swelling of the tissue, a treatment similar to that performed on stroke victims. After a period of recovery that may last as long as six months, the open skull is fitted with an acrylic plate and closed permanently. Today, the number of severely brain-injured soldiers successfully rescued using these techniques has risen to about 50%, with a third of these soldiers returning to unassisted lifestyles. With almost 1.5 million Americans sustaining TBIs each year, the techniques mastered on the battlefield have migrated into the conventional regimens applied in stateside hospitals. Dr. Armondo, a West Point graduate and Army colonel, serves as director of cerebrovascular surgery and interventional neuroradiology at the Walter Reed Army Medical Center and the Bethesda National Naval Medical Center, and also has a private practice. Among his best-known patients is ABC news reporter Bob Woodruff, who in January of 2006 was injured by an IED in Iraq while reporting on the war. In Lee Woodruff's published account of her husband's catastrophic injury, the reporter's all-but-impossible return not only to normal functioning but to his former profession is largely credited to Dr. Armondo's pioneering techniques.

Preparing for Tomorrow's Battles

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