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How War Brings About Medical Advances - Part V

Army Col. (ret) Rocco A. Armonda, MD
U.S. Army
Army Col. (ret) Rocco A. Armonda, MD

So, military doctors wondered, how to relieve the pressure within the soldier’s skull without killing him? The answer was something called a craniectomy. The inventor was an Army neurosurgeon named Col. Rocco Armonda.

All Armonda ever wanted was to be an officer in the Army Medical Corps. At age 17 he joined the Army by attending the United States Military Academy at West Point. He earned his medical degree at the Uniformed Services University of the Health Sciences in Bethesda. He completed his Neurosurgery Residency at Walter Reed Army Medical Center in Washington, D.C.

Tan and youthful-looking, Armonda was deployed to Iraq at the war’s beginning in March 2003. He was the Commander of the 207th Neurosurgery Team, and it was his job to perform surgery on the injured soldiers who came into his medical tent.

Armonda was inundated with head wounds. No one yet had figured out how to solve the problem of intracranial pressure. It was up to Armonda and his colleagues to figure something out, and quick, before another soldier died needlessly of a swollen brain.

Back at Walter Reed, Armonda and his staff had worked on the kind of things you’d find at a civilian hospital. They removed brain tumors, treated spinal abnormalities. And, they performed surgeries on stroke victims.

And there lay the answer, as Stars and Stripes reported in a special 2013 series called "Cracking Skulls and Saving Brains."

Surgeons performing a decompressive craniectomy
Surgeons performing a decompressive craniectomy

Doctors had used a procedure called a decompressive craniectomy for years as a way to treat brain swelling in stroke patients. Armonda knew it might be the only way to save his military patients’ lives.

The first craniectomy didn’t go well. The piece of skull Armonda and his colleagues removed from the wounded soldier wasn’t big enough, and the surgery not performed quickly enough. The patient didn’t survive.

But the surgeons learned from their mistakes. Soon they were performing at least five craniectomies a month as the war in Iraq heated up. During Armonda’s first year in Iraq, the team, dubbed “Team Skull Cracker,” performed roughly 70 craniectomies. The battles that took place 2004 in Fallujah increased the number of craniectomies to 200.

Today the craniectomy is a standard treatment for penetrating brain injuries.