Wartime Penetrating Traumatic Brain Injury of the Anterior Skull Base Involving the Paranasal Sinuses: A Single Center, First Year Experience from Dnipro, Ukraine

Saturday, May 4, 2024

1:45 PM – 1:47 PM CT

Location: S405a

Presenting Author(s)

Connor D. Berlin, MD

Neurosurgery Resident
University of Virginia Department of Neurosurgery
Charlottesville, VA, US

Co-Author(s)

Rocco A. Armonda, MD, FAANS

Director of Neuroendovascular Surgery
Medstar Washington Hospital Center
Silver Spring, MD, US
Sarah E. Johnson, MBBS

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
RM

Rostislav Malyi, MD

Neurosurgeon
Dnipropetrovsk Regional Clinical Hospital
Dnipro, Dnipropetrovs'ka Oblast', Ukraine
BN

Bhiken Naik, MD

Professor of Anesthesiology
University of Virginia, Virginia, United States
MP

Min Park, MD

Professor of Neurosurgery
University of Virginia
Charlottesville, Virginia, United States
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
AS

Andriy Sirko, MD, PhD, CSD

Head of the Cerebral Neurosurgery Center of the Dnipropetrovsk Regional Clinical Hospital
Dnipropetrovsk Regional Clinical Hospital
Dnipro, Dnipropetrovs'ka Oblast', Ukraine
LT

Luke Tomycz, MD

Neurosurgeon
Hackensack University Medical Center, New Jersey, United States

Disclosure(s):

Connor D. Berlin, MD: No financial relationships to disclose

Rocco A. Armonda, MD, FAANS: No financial relationships to disclose

Sarah E. Johnson, MBBS: No financial relationships to disclose

Mark Shaffrey, MD: No financial relationships to disclose

Introduction: Since February 2022, the number of Ukrainian soldier deaths in the Ukrainian-Russia war has increased, with a high incidence of penetrating traumatic brain injuries (pTBI). As the nature of combat continues to evolve, there has been limited assessment of treatment for pTBI of the anterior skull base involving the paranasal sinuses in combat theaters.

Methods: This was a single-institution, retrospective review of the first year of the Ukranian-Russian war at a frontline civilian Ukrainian hospital, which received over 20,000 casualties. To prevent complications from conservative treatment of pTBI with paranasal sinus injury, neurosurgeons implemented a protocol of early primary neurosurgical treatment, debridement/hematoma evacuation, repair of dural defects with vascularized pericranial flaps, and titanium plating of external/skull base defects. Using Glascow Outcome Scale (GOS) criteria, favorable outcome was defined as good recovery/moderate disability, and poor outcome was defined severe disability/vegetative state/death. Baseline demographics, injury characteristics, surgery characteristics, imaging findings and postoperative complications were assessed.

Results: Over 1 year there were 702 casualties with pTBI. A total of 143 pTBI patients with paranasal sinuses involvement were identified, with 23 (16%) having poor outcome and 120 (84%) having favorable outcome. Most pTBIs (69.2%) were also polytraumas, and 136 (95.1%) of pTBIs were due to shrapnel. While 48 patients (34%) presented with CSF leak, only 2 patients (1.4%) had persistent postoperative CSF leak, and only 1 patient (0.7%) developed postoperative meningitis. Average transfer time from injury to hospital was 11.05 + 14.2 hours. Time from admission to craniotomy was 4.43 + 6.37 hours. There were no significant differences observed in the reconstructive techniques applied to the paranasal sinuses or dura amongst both groups.

Conclusion : This is the largest single-year study on neurosurgical treatment of wartime pTBI involving the paranasal sinuses. The use of a new, aggressive protocol of primary neurosurgical intervention at the time of presentation marks a significant shift in early definitive skull base reconstruction protocols, and resulted in low rates of postoperative CSF leak, meningitis, and other complications.