[Neurosurgical management of combat-related penetrating traumatic brain injury - lessons from 10 years of war in Ukraine].

Unlike in previous recent conflicts, the casualties in the Ukrainian war are close to advanced medical facilities. We review lessons learned by the neurosurgical service at Mechnikov Dnipropetrovsk Regional Clinical Hospital (MDRCH). Aggressive and early combined treatment of injuries to the brain, the skull and the skull base reduces complications and improves outcomes. Use of the operating microscope optimizes careful handling of tissue. Pericranial flaps that retain vascularized pedicles are extensively used. Initial CT scanning and catheter-based angiography is liberally used if injury to the cerebral vasculature is seen or suspected. Traumatic pseudoaneurysms and arteriovenous fistulae are immediately treated, followed by open craniotomy for hematoma evacuation and calvarial reconstruction. With early and aggressive surgery and postoperative critical care, even the most severely injured patients can expect good recoveries. Premature decisions to withhold or withdraw care should be avoided.