Factors Related to Recurrence and Complications after Percutaneous Subdural Tapping for Chronic Subdural Hematomas (Aoki Method): Clinical Experiences of 383 Patients with Chronic Subdural Hematomas

Chronic subdural hematoma is a common disease in the field of neurosurgery, and the number of cases is expected to continue increasing in an aging society. At our hospital, minimally invasive percutaneous subdural perforation (the Aoki method) is the first-line treatment. We investigated the recurrence rate associated with the Aoki method, factors related to recurrence, and the complication risks. Among the cases treated with the Aoki method between June 2007 and December 2020, 383 (431 lesions) for which image analysis and recurrence tracking were possible were included. On the basis of the preoperative patient background (sex, age, history of taking antiplatelet and anticoagulant drugs, preoperative neurological findings, imaging findings (preoperative hematoma volume and hematoma density), surgical details, and postoperative use of concomitant drugs), we retrospectively analyzed the recurrence rate, factors related to recurrence, and complication risk. The recurrence rate was 23.7%, which is within the same range as that of burr-hole hematoma irrigation. Multivariate analysis showed that age and a large preoperative hematoma volume were associated with recurrence. One of the 3 cases with postoperative epidural and 2 of the 3 cases with subdural hematomas required craniotomy. The incidence of complications requiring additional surgery was approximately 1%, which is comparable to that of burr-hole irrigation. The Aoki method is efficient because it is minimally invasive and has a therapeutic effect equivalent to that of burr-hole irrigation, which is the current standard of care.