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Lt. Col., Yusuf Izci

M ilitary neurosurgery has a very long and proud tradition of service and innovation that comes to the forefront during periods of peace and war. Modern military surgery in the Ottoman army began with the establishment of Military Medical School in 1827. This school educated and trained the medical students in the European style. This was an evidence-based and secular education without the influence of traditions and religious rules. The history of military neurosurgery in the Ottoman army began with Cemil Pasha (Topuzlu) who was the general surgeon. This

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Paul Klimo Jr. and Brian T. Ragel

. References 1 Armonda RA , Bell RS , Vo AH , Ling G , DeGraba TJ , Crandall B , : Wartime traumatic cerebral vasospasm: recent review of combat casualties . Neurosurgery 59 : 1215 – 1225 , 2006 10.1227/01.NEU.0000249190.46033.94 2 Bell RS , Vo AH , Neal CJ , Tigno J , Roberts R , Mossop C , : Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system . J Trauma 66 : S104 – S111 , 2009 3 Klimo P , Ragel BT : Military

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Uwe Max Mauer, Chris Schulz, Ronny Rothe, and Ulrich Kunz

History of German Military Neurosurgery In Germany, the first surgical procedures involving the nervous system were performed by physicians who had started training in surgery or neurology and who had been influenced by events in World Wars I and II. In 1934, Wilhelm Toennis (1898–1978) established the first independent neurosurgical department in Germany in Wuerzburg. In 1936, he founded the first ever neurosurgical journal. During World War II, he became brigadier general in the medical corps of the German Air Force and was awarded the Knight's Cross with

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Randy S. Bell, Chris J. Neal, and Randall McCafferty

before encountered in human history. 4 In 2010, Paul Klimo and Brian Ragel spearheaded the first issue of Neurosurgical Focus ever dedicated to military neurosurgery. That issue highlighted numerous neurosurgical advances, including the use of early decompressive craniectomy in penetrating brain injury, 1 advances in the management of penetrating spinal column injury, 3 and the utility of a highly specialized aeromedical evacuation system in the management of severe TBI. 2 It was a truly global issue with contributions from authors around the world, and it

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Yavor Enchev and Tihomir Eftimov

B ulgaria is a middle-range southeastern European country with a territory of 111,000 km 2 and a population of 7.5 million. The history of Bulgarian military neurosurgery is hard to understand without the knowledge of significant historical facts concerning the political state and the military forces in Bulgaria during the communist regime and the ensuing democratic changes up to the present. Bulgaria in the Communist Era After Bulgaria was proclaimed a People's Republic in 1946, the military rapidly adopted the Soviet military doctrine and

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Commander Ross R. Moquin and Lieutenant Colonel James M. Ecklund

Although the practice of neurosurgery in the United States (US) Armed Forces is in many ways similar to the civilian practice of neurosurgery, there are many differences as well. The unique challenges, duties, and opportunities US military neurosurgeons are given, both in peacetime and in times of conflict, are discussed, as are pathways for entering into service. The advantages of military service for neurosurgeons include sponsored training, decreased direct exposure to tort actions, little involvement with third-party payers, significant opportunities for travel, and military-specific experiences. The most appealing aspect of military practice is serving fellow members of the US Armed Forces. Disadvantages include the extreme gap between the military and civilian pay scales, lack of support personnel, and in some areas low surgery-related case volume. The greatest concern faced by the military neurosurgical community is the failure to retain experienced neurosurgeons after their obligated service time has been completed, for which several possible solutions are described. It is hoped that future changes will make the practice of military neurosurgery attractive enough so that it will be seen as a career in itself and not an obligation to endure before starting practice in the “real world.”

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Harjus Birk, Caleb Stewart, and Jennifer A. Kosty

T he advancement of early neurosurgical innovations can be attributed to neurosurgery’s intense and intimate relationship to war. Dr. Harvey Cushing, regarded as the father of modern neurosurgery, served in World War I between 1915 and 1918. 1 , 2 Using the knowledge and experiences of numerous military surgeons from before his time, including Sir Victor Horsley and Sir Emil Kocher, Dr. Cushing was instrumental in treating soldiers with injuries to the head, spine, and peripheral nerves. 3 , 4 Cushing recognized the value of meticulous note-taking during

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Christiana M. Cornea, Nicole A. Silva, William Sanders Marble, Kristopher Hooten, and Brian Sindelar

. 3 – 6 It is the early military initiatives that set into motion the improvements in morbidity and mortality associated with SCI seen today and the expansion of neurosurgery as an independent surgical specialty. 1 WWI: 1914–1918 WWI brought a new age of deadly trench warfare with advancements in artillery and armor and the invention of the machine gun. Given the use of these weapons, evacuation protocols and frontline surgical care became vital for wounded soldiers. In fact, when pioneering neurosurgeon Harvey Cushing was completing a surgical rotation

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Jonathan E. Martin, Jordan Dean, Chris J. Neal, Benny Brandvold, Richard G. Ellenbogen, Ross R. Moquin, Geoffrey Ling, and James Ecklund

well as on Navy Hospital Ships and Fleet Hospitals. Photographs by Richard G. Ellenbogen. © Richard G. Ellenbogen, published with permission. FIG. 7. Experience of the neurosurgeon in ODS. Neurosurgery in an austere forward environment provided military neurosurgeons with experiences well outside of those encountered in civilian practice. A: ODS was the first conflict to field PASGT (Personnel Armor System for Ground Troops) Kevlar helmets and body armor for deploying troops. Seen here, Majors Richard Ellenbogen and Eric Scott wear their PASGT on the 1st

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Andrew M. Hersh, A. Daniel Davidar, Carly Weber-Levine, Divyaansh Raj, Safwan Alomari, Brendan F. Judy, and Nicholas Theodore

P atients with spinal cord injury (SCI) were generally considered untreatable for most of human history and were associated with a high mortality rate. However, worldwide military conflicts in the 20th century produced a significant number of injured soldiers and necessitated improvements in SCI care; treatment has accordingly progressed significantly over the past century. In present-day military conflicts, increased use of improvised explosive devices (IEDs) and unconventional guerrilla warfare have resulted in high rates of SCI among soldiers. These