During World War I (WWI), the general mobilization of the population led to the enrollment of 60 million soldiers and thousands of casualties. During this period, 25% of the penetrating injuries (gunshot wounds or various fragments devices) were located in the cephalic region, which represents only 15% of the body surface [1]. Ballistics helmets, including the famous Adrian helmet introduced to the French army in 1915 by the French general Adrian, were developed to reduce the increasing number of head injuries. The Adrian helmet was made with a comfortable leather lining surrounded by thick mild steel providing sufficient head coverage (Fig. 1) and was designed to protect soldiers from > 75% of shrapnel hits [2]. Equipment improvements reduced the mortality rate and considerably increased the number of injured soldiers, which overloaded the military hospital facilities [3]. To provide sufficient care for cranial injuries, the American army established a 10-week intensive course named the “70-Day Brain Surgeon” in 1917. This surgical training helped develop neurosurgery as a specialty.

At the onset of WWI, the French Medical Health Service tried to standardize the neurosurgical techniques employed on the field to better manage the huge influx of wounded soldiers. First-class major physician Henri Brodier was a military surgeon who operated on thousands of soldiers with penetrating brain injury (PBI) during the battle of Verdun [4]. Major Brodier wrote his surgical techniques in a book in which he reported every consecutive PBI clinical case that he operated on from August 1914 to July 1916. His work, comprising two volumes, is available at the Bibliothèque Nationale de France (National Library of France). This series of historical cases has never been studied. The study aim was to collect data from Brodier's PBI historical series to investigate the PBI neurosurgical management during this high-intensity conflict and identify and discuss the significant differences in medical care and treatment between soldiers who survived and those who died.