Effect of Postoperative Administration of Saireito for Bilateral Chronic Subdural Hematomas

Satoshi Utsuki, Hidehiro Oka, Chihiro Kijima, Madoka Inukai, Katsutoshi Abe, Kimitoshi Sato, Sachio Suzuki, Kiyotaka Fujii

.

DOI: 10.4236/ijcm.2011.23047                

Abstract

The aim of this retrospective study was to investigate the efficacy of saireito for bilateral chronic subdural hematomas (B-CSDH). Between April 2006 and March 2010, a total of 18 patients undergoing unilateral burr hole drainage for B-CSDH took part in a controlled clinical study. Postoperative status of the nonsurgical side was subsequently evaluated, with (n = 10) and without (n = 8) saireito administration. Two in the saireito-treated group patients and four in the control group patients ultimately required contralateral surgical intervention. The remainder, including eight saireito-treated hematomas, resolved without further surgery, generally within eight weeks of the surgical side procedure. However, two of the four resolving control lesions took longer to regress. The hydragogue and anti-inflammatory/steroid-evoking properties ascribed to saireito may facilitate hematoma resolution. After unilateral surgery for B-CSDH, saireito administration may prevent symptomatic deterioration of a contralateral low-density CSDH, preempting subsequent surgery.

Keywords

Bilateral Chronic Subdural Hematomas, Contralateral Hematoma, Medical Treatment, Saireito, Steroid-Like Effect

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Miyagami and Y. Kagawa, “Effectiveness of Kampo medicine Gorei-San for chronic subdural hematoma,” No Shinkei Geka, Vol. 37, No. 8, 2009, pp. 765-770. (Japanese, with English abstract)
[2]	M. Muramatsu, T. Yoshikawa and K. Hanabusa, “Effectiveness of kampo medicine gorei-san-ryo for chronic subdural hematoma in very elderly patients,” No Shinkei Geka, Vol. 33, No. 10, 2005, pp. 965-969. (Japanese, with English abstract)
[3]	T. F. Sun, R. Boet and W. S.Poon, “Non-surgical primary treatment of chronic subdural haematoma: Preliminary results of using dexamethasone,” B. J Neurosurg, Vol.19, No. 4, 2005, pp. 327-333.
[4]	J. L. Voelker, “Nonoperative treatment of chronic subdural hematoma,” Neurosurg Clin. N Am, Vol. 11, No. 3, 2000, pp. 507-513.
[5]	S. Zarkou, M. I. Aguilar, N. P. Patel, K. E. Wellik, D. M. Wingerchuk and B. M. Demaerschalk, “The role of corticosteroids in the management of chronic subdural hematomas: a critically appraised topic,” Neurologist, Vol. 15, No. 5, 2009, pp. 299-302.
[6]	I. Iwai, T. Suda, F. Tozawa, Y. Nakano, Y. Sato, N. Ohmori, T. Sumitomo, M. Yamada and H. Demura, “Stimulatory effect of Saireito on proopiomelanocortin gene expression in the rat anterior pituitary gland,” Neurosci Lett. 157, Vol. 157, No. 1, 1993, pp. 37-40.
[7]	Y. Nakano, T. Suda, F. Tozawa, I. Dobashi, Y. Sato, N. Ohmori, T. Sumitomo and H. Demura, “ Saireito (a Chinese herbal drug)-stimulated secretion and synthesis of pituitary ACTH are mediated by hypothalamic corticotropin-releasing factor, “ Neurosci Lett, Vol. 160, No. 1, 1993, pp. 93-95.
[8]	K. S. Lee, “Natural history of chronic subdural haematoma,” Brain Inj, Vol. 18, No. 4, 2004, pp. 351-358.
[9]	T. H. Tsai, A. S. Lieu, S. L. Hwang, T. Y. Huang and Y. F. Hwang, “A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes,” J Trauma. Vol. 68, No. 3, 2010, pp. 571-575.
[10]	H. J. Hong, Y. J. Kim, H. J. Yi, Y. Ko, S. J. Oh and J. M. Kim, “Role of angiogenic growth factors and inflammatory cytokine on recurrence of chronic subdural hematoma,” Surg Neurol, Vol. 71, NO. 2, 2009, pp. 161-166.
[11]	H. Fujisawa, S. Nomura, E. Tsuchida and H. Ito, “Serum protein exudation in chronic subdural haematomas: a mechanism for haematoma enlargement?” Acta Neurochir (Wien), Vol. 140, No. 2, 1998, pp. 161-166.
[12]	C. K. Park, K. H. Choi, M. C. Kim, J. K. Kang and C. R. Choi, “Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma,” Acta Neurochir (Wien), Vol. 127, No.1-2, 1994, pp. 41-47.
[13]	S. H. Park, S. H. Lee, J. Park, J. H. Hwang, S. K. Hwang and I. S. Hamm, “Chronic subdural hematoma preceded by traumatic subdural hygroma,” J Clin Neurosci, Vol 15, No. 8, 2008, pp. 868-872.
[14]	T. Ono, N. Liu, T. Makino, F. Nogaki, E. Muso, G. Honda and T. Kita, “Suppressive mechanisms of Sairei-to on mesangial matrix expansion in rat mesangioproliferative glomerulonephritis,” Nephron Exp Nephrol, Vol. 100, No. 3, 2005, pp.e132-142.