Department of Neurosurgery, Madigan Army Medical Center, Tacoma, WA 98431, United States.
Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States.
Mil Med. 2020 Dec 30;185(11-12):2183-2188. doi: 10.1093/milmed/usaa219.
The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care.
We report a retrospective series of far-forward endovascular cases performed by 2 deployed dual-trained neurosurgeons at the role III hospital in Kandahar, Afghanistan during 2013 and 2017 as part of Operations Resolute Support and Enduring Freedom.
A total of 15 patients were identified with ages ranging from 5 to 42 years old. Cases included 13 diagnostic cerebral angiograms, 2 extremity angiograms and interventions, 1 aortogram and pelvic angiogram, 1 bilateral embolization of internal iliac arteries, 1 lingual artery embolization, 1 administration of intra-arterial thrombolytic, and 2 mechanical thrombectomies for acute ischemic stroke. There were no complications from the procedures. Both embolizations resulted in hemorrhage control, and 1 of 2 stroke interventions resulted in the improvement of the NIH stroke scale.
Interventional neuroradiology can fill an important role in military far forward care as these providers can treat both traumatic and atraumatic cerebral and extracranial vascular injuries. In addition, knowledge and skill with vascular access and general interventional radiology principles can be used to aid in other lifesaving interventions. As interventional equipment becomes more available and portable, this relatively young specialty can alter the treatment for servicemen and women who are injured downrange.
介入神经放射学的进步极大地改变了中风和创伤患者的治疗方式。然而，由于专业知识和设备的限制，这些在第一世界医院的进步很少能在前沿军事医院中得到应用。不过，在一家成熟的三级军事医院中，这些救生程序可以成为创伤护理的重要工具。
我们报告了 2 名部署的双重训练神经外科医生在阿富汗坎大哈的三级医院进行的一系列远前沿血管内病例，这些病例是作为“坚决支持行动”和“持久自由行动”的一部分在 2013 年和 2017 年进行的。
共确定了 15 例患者，年龄从 5 岁到 42 岁不等。病例包括 13 例诊断性脑血管造影、2 例肢体血管造影和介入治疗、1 例主动脉造影和骨盆血管造影、1 例双侧髂内动脉栓塞、1 例舌动脉栓塞、1 例动脉内溶栓治疗和 2 例急性缺血性脑卒中机械取栓术。手术过程中没有发生并发症。两次栓塞均成功控制了出血，两次脑卒中干预中有一次使 NIH 脑卒中量表评分得到了改善。
介入神经放射学可以在军事前沿医疗中发挥重要作用，因为这些提供者可以治疗创伤性和非创伤性的脑和颅外血管损伤。此外，血管通路和一般介入放射学原理的知识和技能可以用于辅助其他救生干预措施。随着介入设备变得更加可用和便携，这个相对年轻的专业可以改变在海外受伤的军人的治疗方法。
