Akitake Okamura* and Yukihiko Kawamoto
We previously reported the recurrence factors and the effect of Gorei-san on chronic subdural hematoma (CSDH) using percutaneous subdural tapping. Herein, we comment on less invasive surgical option and postsurgical administration for CSDH. Many factors for CSDH recurrence have been identified and categorized into four groups, namely: patient background, hematoma character, postsurgical administration, and surgical option. Patient background and hematoma character cannot be intervened for patients’ specific problem. Gorei-san has been reported to prevent CSDH recurrence without adverse events even if administered for elder patients. Gorei-san inhibits aquaporin-4, which is expressed on the outer membrane of chronic subdural hematoma. We have good impression of prevention effect of CSDH recurrence especially for those who started Gorei-san before surgery. Several surgical options for CSDH are reported as follows: burr hole surgery, percutaneous subdural tapping, endovascular embolization of middle meningeal artery, and craniotomy. Although burr hole surgery has been performed worldwide as a standard procedure for CSDH, percutaneous subdural tapping has been developed to realize less invasive surgical option, which allows noninvasive measurement of initial hematoma pressure and eases the perioperative management due to rapid discharge.
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