Effects of atorvastatin on chronic subdural hematoma: A preliminary report from three medical centers

Wang, Dong; Li, Tuo; Tian, Ye; Wang, Shaobo; Chunjie, Jin; Wei, Huijie; Quan, Wei; Wang, Jinghua; Chen, Jieli; Dong, Jing‐fei; Jiang, Rongcai; Zhang, Jianning

doi:10.1016/j.jns.2013.11.005

Cited by 102 publications

(95 citation statements)

References 44 publications

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“…25 In this study, we were using a low dosage which was the same dose as in a previously reported preliminary study on CSDH patients. 20 This same dosage is also used in the protocol of an on-going randomised controlled trial. 26 In this study, 58.3% in the control group deteriorated requiring burr-hole drainage.…”

Section: Discussionmentioning

confidence: 99%

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The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chan

Sun

et al. 2016

British Journal of Neurosurgery

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Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS-and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p ¼ 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p ¼ 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p ¼ 0.0451). The Number needed to treat (NNT) was 2.4 (p ¼ 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

“…19 In a preliminary clinical trial, 75% of the patients with Atorvastatin had haematoma resolution in 3 months. 20 The aim of our study was to investigate the efficacy of Atorvastatin on CSDH and to generate a potential sample size for future randomised control trial.…”

Section: Introductionmentioning

confidence: 99%

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chan

Sun

et al. 2016

British Journal of Neurosurgery

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“…Hematoma was completely resolved in 17 of the 23 patients (77.3 %) 3 months after the treatment was initiated [21]. Whether atorvastatin is effective in reducing surgical recurrence remains to be tested in a future prospective study.…”

Section: Discussionmentioning

confidence: 96%

Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation

2015

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Background: Chronic subdural hematoma is a common neurosurgical condition especially in the aging population. Burr hole for drainage is an effective treatment, yet recurrence is reported at 8 to 22 % worldwide, and 1-year mortality rates could be as high as 32 %. Our previous study on the use of dexamethasone as a primary nonsurgical treatment showed good response in selected group of patients. This study aims to assess the efficacy of dexamethasone with surgical drainage in the reduction of recurrence requiring reoperation. Methods: From October 2000 to September 2006, patients with chronic subdural hematoma admitted to the Prince of Wales Hospital, The Chinese University of Hong Kong, were randomized to surgical drainage with steroid versus surgical drainage only. The primary endpoint was symptomatic recurrence requiring reoperation. Results: Two hundred forty-eight patients were recruited and consented for the randomization during the study period. One hundred twenty-two received both surgery and steroid (the intervention arm) while 126 received surgery only (the control arm). The recurrence rate requiring reoperation was 6.6 % (8/122) and 13.5 % (17/126), respectively (p = 0.109). There was no significant difference in complications such as chest infection (p = 0.201) or wound infection (p = 0.987). Favorable outcome (Glasgow Outcome Score 4-5) was 104/122 (85.2 %) in the intervention group versus 105/126 (83.3 %) in the control group, respectively (p = 0.811). Based on the recurrence rate in our study, we generate a potential sample size of at least 594 patients (type I error = 5 %, power = 80 %, two-sided test) to detect a significant difference. Conclusions, brief summary, and potential implications: In this prospective pilot phase IIB randomized controlled study, steroid with surgical drainage had a lower recurrence with reoperation though statistically insignificant. It was safe with no significant difference in complication rates. This pilot study generates a potential sample size for a definitive larger double-blinded randomized controlled trial in the future.

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“…Aberrant angiogenesis and localized inflammation contribute to the formation of cSDH. Atorvastatin is active in promoting angiogenesis and modulating inflammation26). There is increasing evidence that impaired angiogenesis in the neomembrane and localized inflammation play a key role in the formation of a cSDH.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment might generally be indicated in conditions of large hematoma width (>10 mm) or shift of the midline (>5 mm) on brain computed tomography (CT) scan and surgical intervention has been accepted as the treatment of choice8). However, its outcomes may not be satisfactory because of recurrence and physical infirmity associated with aging26). The reported rate of recurrence after surgery for cSDH is approximately 5–30%11).…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy

Kim

Yoo

et al. 2016

J Korean Neurosurg Soc

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ObjectiveChronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality.MethodsWe enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale.ResultsAmong these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm.ConclusionWe suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration.

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Effects of atorvastatin on chronic subdural hematoma: A preliminary report from three medical centers

Cited by 102 publications

References 44 publications

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation

Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy

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