120 Blast-Related Traumatic Brain Injuries Secondary to Thermobaric Explosives: Implications for the War in Ukraine. (April 2023)

• Record Type: Journal Article
• Authors: Zhang, Justin; Botterbush, Kathleen; Bagdady, Kazimir; Mercier, Philippe; Mattei, Tobias A.
• Is Part Of: Neurosurgery. Volume 69(2023)Supplement 1
• Page Start: 29
• Page End: 29
• Publication Date: 2023-04
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002375_120
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Advancements in modern weaponry have vastly increased the incidence and severity of craniospinal injuries. Specifically, thermobaric weapons can cause devastating blast-related traumatic brain injury (bTBI). With recent use of these weapons in the war in Ukraine, clinicians and laypersons alike may benefit from an improved understanding behind the dynamic interplay between explosive weaponry, its potential for bTBI, and the subsequent short and long-term consequences of these injuries. METHODS: A comprehensive review of thermobaric weapons and their use throughout history was performed. Mechanisms of action behind blast injuries and subsequent therapeutic advancements in neurosurgical management from pioneers of neurosurgery was conducted. We document long term neuropsychiatric sequela following bTBI and discuss its relevance in the current conflict in Ukraine. In addition, a quantitative analysis of the potential of thermobaric weapons to cause bTBI in a hypothetical scenario of its use in Ukrainian civilian zones was performed. RESULTS: A thermobaric weapon causes a prolonged blast pressure wave which can cause devastating injury through several mechanisms, including long-term neuropsychiatric sequela (notably PTSD). The origins of bTBI sequela date back to documentations in WWI of "shell-shock", now widely known as PTSD. Trailblazers in neurosurgery, such as Harvey Cushing, and prominent psychologists, such as Charles Myers, were pivotal in identifying and treating early cases of bTBI. Our quantitative analysis demonstrates the significant potential of thermobaric weapons in causing bTBI. Construction of underground shelters may mitigate damage from the blast pressure wave. CONCLUSIONS: As humanitarian relief efforts set foot in Ukraine, results from our brief report may inform and assist the development of focused mitigation and rehabilitation strategies, especially in post-war reconstruction