Neurosurgical trauma in Japan

According to the statistics compiled by the Institute for Traffic Accident Research and Data Analysis, the total number of head trauma patients has stayed virtually the same for the last 10 years in Japan, although a fraction of people suffering minor head trauma has shown a trend to increase. The Japan Society of Neurotraumatology is in the process of establishing a guideline for head trauma management. No major difference is noted in surgical procedures selected by neurosurgeons in Japan as compared to those in other countries. It appears, however, that the ventriculostomy may be less frequently employed to control elevated intracranial pressure, and the jugular bulb venous oximetry is far more frequently employed to detect cerebral deoxygenation in Japan. There appear to be two obvious differences in selection of pharmacological therapies among neurosurgeons in Japan and those in other countries; neurosurgeons in Japan prefer glycerol to mannitol for osmotic control of intracranial pressure, and barbiturate to morphine as sedatives. Two drugs are currently available in Japan for promoting the recovery from disturbance of consciousness after head trauma: cytidine diphosphate choline (CDP)-choline (Nicholin, Takeda Chemical Industries, Ltd., Osaka) and protirelin tartrate (Hirtonin; thyrotropinreleasing hormone (TRH) analogue, Takeda). Another TRH analogue, NS-3 (montirelin hydrate), is currently submitted to the Ministry of Health and Welfare for approval. A multi-institutional controlled study to examine the efficacy of therapeutic hypothermia for head trauma management is now in progress in Japan. The Japan Neurotrauma Data Bank System was inaugurated 2 years ago, enabling joint statistical processing at 10 major neurotrauma centers. Utilizing such a system, more detailed analysis of head trauma management will be possible, and clinical trials will be conducted systematically and more promptly in future.