23 March 2013

One Ranger's road to recovery: Aggressive use of craniectomies kept him and others like him alive

In January 2013, Staff Sgt. Dominic Annecchini sits next to a plastic mold of his skull that shows the piece that was taken out after he was shot in Afghanistan. Annecchini had a cranioplasty to replace his bone with a prosthetic piece the week before. Photo: Megan McCloskey, Stars and Stripes.

In 2003, doctors deployed in Iraq started seeing serious head traumas — the kind that used to mean these troops would never make it off the battlefield. The only two Army neurosurgeons in Iraq at the time realized they would die without a new way of dealing with the trauma. They looked to a technique used for decades to treat stroke patients: decompressive craniectomy - opening the skull to relieve pressure.

Today, one of them, Col. (Dr.) Rocco Armonda, is treating patients at Walter Reed National Military Medical Center. Megan McCloskey of Stars and Stripes has written a fascinating article about him, this treatment method, and one of his patients - Army Ranger Staff Sgt. Dominic Annecchini, who sustained a gunshot wound to the head in May of 2012.

[Staff Sgt. Dominic] Annecchini's platoon with the 1st Battalion, 75th Ranger Regiment was in the mountains of Eastern Afghanistan training Afghan soldiers. In the dark of night on May 16, 2012, like he had on hundreds of other missions, the staff sergeant led a group to clear a house on a last-minute raid.

He opened the door for an Afghan counterpart, who then crossed into the entryway and was immediately taken out by AK-47 fire, falling into the room with the enemy. As Annecchini stepped into the line of fire to pull the Afghan out of the kill zone, a bullet bore through his night vision goggles and fragments studded his skull and brain above his right eye.

When he arrived at the combat support hospital in Bagram, the mounting pressure inside his skull threatened his life.

To rescue the brain, neurosurgeons cut open Annecchini’s head and excised his entire forehead.

After his craniectomy, Annecchini was in a medically induced coma for three days.

“I remember pulling security on the door and the next thing I remember I woke up in Germany,” he said.

Confused and looking around the Landstuhl Regional Medical Center hospital room, wondering where he was, a nurse leaned over and told him the news.

When he was first given a small hand mirror in the hospital bed, he didn’t look long.

“Oh, man,” he thought, quickly putting his reflection away.

He knew then his high speed life was over.

His right eye was swollen shut and his forehead was so massive from swelling, he thought he looked like the animated character Megamind, who has an oversized, alien-like head. He could barely speak and he couldn’t move his right arm or leg. Forty percent of his right frontal lobe had been damaged by bullet and bone fragments.

“The night vision goggles probably absorbed the majority of the gunshot blast, because otherwise he would probably be blinded and in a much worse state,” Armonda said.

Annecchini’s speech came back quickly, but it was as if he was paralyzed on his right side.

“He was pretty frustrated,” his wife Melanie Annecchini said. “He’d get annoyed trying to feed himself and get aggravated with me, because I wouldn’t let anyone help him. I made him do it on his own.”

She said he often tried to cheat by using his left arm to lift his right, which she shut down immediately. “He’d tell everyone, ‘She’s so mean to me!’ ”

He spent 10 days at Walter Reed and then went to the Department of Veterans Affairs Palo Alto Polytrauma Rehabilitation Center in California for intensive, daily therapy. From June through August, he did speech, language, physical, occupational and recreational rehab every day.

Where the conventional thinking after these types of head traumas used to be that patients might be saved for lives not worth living, the results are encouraging: About 60% have functional independence versus about 10%t of head trauma patients in the civilian world.

Meanwhile, Staff Sergeant Annecchini has re-enlisted in the Army at the VA center in Palo Alto. He knows he'll have to give up being a Ranger, but hopes to stay in the special forces community to contribute however he can.

Last year he did a 5k race using a cane and came in dead last. It was a far cry from life before his injury, but he hasn't given up running again.

“That’s something he’s very motivated to do,” Dr. Armonda said. “He’s a Ranger, so he’s going to set his sights pretty high, and [running is] part of their vision of themselves as having completely healed.”

Make sure to read this entire terrific article.

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