Department of Neurosurgery, Faculty of Medicine, University of Tsukuba.
Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital.
Neurol Med Chir (Tokyo). 2023 Jan 15;63(1):31-36. doi: 10.2176/jns-nmc.2022-0229. Epub 2022 Oct 25.
Most asymptomatic patients with chronic subdural hematoma (CSDH) are followed conservatively but can require surgical treatment if the hematoma expands. We conducted a retrospective evaluation of the effect of Gorei-san on CSDH. This study included patients treated between April 2013 and March 2015. In total, 289 patients were diagnosed with CSDH and 110 patients received conservative management. Finally, 39 patients who met the requirements were registered. We retrospectively examined the age, gender, medical history, hematoma thickness, clarity of sulci below hematomas, and midline shift of the patients. The primary outcome was the median surgery-free interval, and the secondary results were the rate of CSDH shrinkage and surgery avoidance. A comparison of patient characteristics between the Gorei-san (G) and non-Gorei-san (NG) groups found no significant differences in the percentage of men, average ages, past history, thickness of CSDH (15.0 ± 3.1 mm vs. 15.3 ± 2.6 mm, p = 0.801), or midline shift (2.0 ± 2.7 mm vs. 4.0 ± 5.0 mm, p = 0.230). The median surgery-free interval was significantly different between the G and NG groups [n. r. vs. 41 days (95% CI: 5-79), log-rank p = 0.047]. The CSDH avoidance rate was not significantly different between the two groups (70.0% vs. 34.4%, p = 0.071). Additionally, the CSDH shrinkage rate was significantly different between the two groups (60.0% vs. 10.3%, p = 0.004). This retrospective study demonstrated that CSDH treatment with Gorei-san reduces hematoma significantly more than treatment that does not include Gorei-san.
大多数慢性硬脑膜下血肿（CSDH）的无症状患者采用保守治疗，但如果血肿扩大，则需要手术治疗。我们对 Gorei-san 治疗 CSDH 的效果进行了回顾性评估。这项研究纳入了 2013 年 4 月至 2015 年 3 月间接受治疗的患者。共有 289 例患者被诊断为 CSDH，110 例患者接受了保守治疗。最终，有 39 例符合要求的患者被注册。我们回顾性检查了患者的年龄、性别、病史、血肿厚度、血肿下方脑沟的清晰度和中线移位情况。主要结局是无手术间隔的中位数，次要结果是 CSDH 缩小率和避免手术率。对 Gorei-san（G）和非 Gorei-san（NG）两组患者的特征进行比较，发现两组男性比例、平均年龄、既往史、CSDH 厚度（15.0 ± 3.1mm 对 15.3 ± 2.6mm，p = 0.801）和中线移位（2.0 ± 2.7mm 对 4.0 ± 5.0mm，p = 0.230）无显著差异。G 组和 NG 组的无手术间隔中位数差异有统计学意义[n.r. 对 41 天（95%CI：5-79），对数秩检验 p = 0.047]。两组的 CSDH 避免率无显著差异（70.0%对 34.4%，p = 0.071）。此外，两组的 CSDH 缩小率差异有统计学意义（60.0%对 10.3%，p = 0.004）。这项回顾性研究表明，与不包含 Gorei-san 的治疗相比，Gorei-san 治疗 CSDH 可使血肿显著缩小。
