Redo Surgery after War-Related Traumatic Brain Injuries in Modern Warfare

Introduction. A complicated operational environment in modern local military conflicts may turn toward performing nonradical neurosurgery in TIER 3 that requires reoperations (reop) at TIER 5 units. Nowadays there is gap of knowledge regarding the characteristics of reops performed for war-related traumatic brain injury (TBI) in central military medical institutions. Purpose. To evaluate indications and the nature of re-op for war-related TBI in the Central military hospital. Materials and methods. A retrospective study of 125 reoperations was performed at the State Military Hospital named after A.A. Vishnevsky in Russia among male combatants aged 20–50 years with war-related TBI in 2023–2024. The inclusion criteria were: blast, mine-explosive wound, leading combat TBI, and non-penetrating combined injury of other localization. Statistical processing of reops indications and outcomes was performed by R 4.5.0 (Austria) with calculation of exact binomial 95% confidence intervals (95% CI). Differences between groups were considered statistically significant at p<0.05. Results. Indications for reoperation were: inadequate craniectomy (n=62 (49.6%)), deep infectious complications (n=45 (36%)), cerebrospinal fluid fistula (n=43 (34.4%)), superficial infectious complications (n=22 (17.6%)), intracerebral hematomas (n=12 (9.6%)), subdural hematomas, and contusions (n=5 (4%)). Types of performed reops consisted of decompressive craniectomy (n=8, (67.2%)), autoduraplasty and alloduraplasty (n=59 (47.2%), n=50 (40%)), drainage of cerebrospinal fluid spaces (n=39 (31.2%)), removing fragments of projectiles (n=28 (22.4%)), revision of postoperative sites (n=26 (20.8%), removing intracerebral hematomas (n=25, (20%)), debridement (n=22 (17.6%)), removing bones fragments (n=20 (16%)), resection craniotomy (n=19 (15.2%)), and removing brain abscess (n=2 (1.6%)). The rate of improvement after reops was 47.2%. [95% CI: 38.2; 56.3] (59 patients). The overall mortality after reops was 17.6% [95% CI: 11.4; 25.4] (22 deaths). A statistically significant association of the type of injury with the risk of death was found (p=0.03) in patients with diametrical injuries. A comparative analysis revealed a monotonic trend towards decreasing frequency of death with increasing Glasgow Coma Scale score (p=0.003). Deep infectious complications were statistically significantly associated with increasing risk of poor outcome by 2.57 [95% CI: 1.19; 5.53] times (p=0.026). Conclusion. Patients who underwent repeated neurosurgical interventions represented a heterogeneous cohort depending on the leading indication for reop. It is advisable to prioritize decompressive craniotomy and watertight duraplasty during initial surgery after war-related traumatic brain injuries in modern warfare. © 2025 Elsevier B.V., All rights reserved.