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.