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Monteiro GDA, Queiroz TSD, Gonçalves OR, Cavalcante-Neto JF, Batista S, Rabelo NN, Welling LC, Figueiredo EG, Leal PRL, Solla DJF. Efficacy and Safety of Atorvastatin for Chronic Subdural Hematoma: An Updated Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:177-184. [PMID: 38759787 DOI: 10.1016/j.wneu.2024.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common neurological condition, especially in the elderly population. Atorvastatin has shown the potential to reduce the recurrence of CSDH and improve overall outcomes. New studies have emerged since the last meta-analysis, increasing the sample size and the variety of outcomes analyzed. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies comparing the use of atorvastatin in CSDH patients with a control group or placebo. The primary outcome was the recurrence of CSDH. Secondary outcomes of interest were hematoma volume, composite adverse effects, mortality, and neurological function, measured by the Glasgow Outcome Scale and Barthel index for activities of daily living. RESULTS Seven studies, of which 2 were randomized controlled trials, were included, containing 1192 patients. Overall recurrence significantly decreased compared to the control group (risk ratio [RR] 0.46; 95% confidence interval [CI] 0.25-0.83; P=0.009). The benefits of atorvastatin were sustained in the subgroup analysis of patients who underwent initial conservative therapy (RR 0.40; 95% CI 0.22-0.70; P=0.001). However, there was no significant difference when atorvastatin was combined with surgical intervention (RR 0.53; 95% CI 0.21-1.32; P=0.17). Adverse effects were not increased by atorvastatin (RR 0.82; 95% CI 0.51-1.34; P=0.44). CONCLUSIONS Atorvastatin might be beneficial in reducing CSDH recurrence, especially in conservative treatment patients. Atorvastatin was not significantly associated with adverse effects. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy, safety, and optimal dose of atorvastatin in CSDH patients.
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Affiliation(s)
| | | | | | - Joaquim Francisco Cavalcante-Neto
- Department of Neurosurgery, Federal University of Ceara, Sobral, Brazil; Department of Neurosurgery, Hospital do Servidor Público Estadual, IAMSPE, São Paulo, Brazil
| | - Sávio Batista
- Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, Brazil
| | | | | | | | | | - Davi Jorge Fontoura Solla
- Division of Neurosurgery, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Zhong D, Cheng H, Xian Z, Ren Y, Li H, Ou X, Liu P. Advances in pathogenic mechanisms, diagnostic methods, surgical and non-surgical treatment, and potential recurrence factors of Chronic Subdural Hematoma: A review. Clin Neurol Neurosurg 2024; 242:108323. [PMID: 38749358 DOI: 10.1016/j.clineuro.2024.108323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024]
Abstract
Chronic Subdural Hematoma (CSDH) is a common hemorrhagic disease in neurosurgery, and with the intensification of global aging, its incidence is gradually increasing. With the advancement of scientific technology, the etiological concepts and surgical treatments for CSDH have continually evolved over time. Currently, neuroscientists' understanding of CSDH is no longer confined to bridging vein rupture; exploration of various mechanisms such as angiogenesis, maturation of blood vessels, and inflammation is also underway. In-depth exploration and discovery of pathogenic mechanisms guide the updating of clinical treatment strategies and methods. For different types of CSDH, there is now a clear guidance for the targeted selection of treatment methods. However, the current treatment of CSDH cannot completely solve all problems, and the updating of treatment methods as well as the development and validation of new effective drugs remain challenges for the future. In addition, the recurrence of CSDH is a significant issue that needs to be addressed. Although we have reviewed potential recurrent factors that may be associated, the strength of this evidence is insufficient. Future research should gradually focus on validating these recurrent factors and exploring new ones, in order to optimize the existing understanding and treatment of CSDH.
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Affiliation(s)
- Dayuan Zhong
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China; Neurosurgery, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China
| | - Hui Cheng
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China; Neurosurgery, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China
| | - Zhuoyan Xian
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China
| | - Yanhai Ren
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China; Neurosurgery, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China
| | - Huanjie Li
- Department of Preventive Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528051, China.
| | - Xueming Ou
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China; Neurosurgery, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China.
| | - Pingwen Liu
- Nanhai hospital of Traditional Chinese Medicine, Jinan University, Foshan 528200, China; Neurosurgery, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China.
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Wang B, Li K, Guo C, Wang Z, Zhu W, Lu C. Evaluation of Effectiveness of Atorvastatin in Treating Chronic Subdural Hematoma not Requiring Surgery: A Meta-Analysis of Randomized Controlled Trials. Ann Indian Acad Neurol 2024; 27:19-26. [PMID: 38495243 PMCID: PMC10941892 DOI: 10.4103/aian.aian_818_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 03/19/2024] Open
Abstract
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between the arachnoid membrane and the dura mater. Atorvastatin is of increasing clinical interest for CSDH. We performed a meta-analysis of published randomized controlled trials (RCTs) and used objective data as the primary outcomes to provide an evidence-based analysis of the efficacy of atorvastatin for CSDH treatment. Databases of MEDLINE (via PubMed), EMBASE, the Cochrane Library, Scopus, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure (CNKI), Cqvip database (CQVIP), and Wanfang database were systematically searched for RCTs reporting the use of atorvastatin for CSDH treatment. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used as summary statistics. I-square (I2) test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Nine relevant RCTs with 611 patients were identified for inclusion in this meta-analysis. Compared to controls, atorvastatin treatment had a significantly higher effectiveness (OR: 7.41, 95% CI: 3.32-16.52, P < 0.00001, I2 = 0%), lower hematoma volume (SMD: -0.46. 95% CI: -0.71 to -0.20, P = 0.0005, I2 = 0%), higher activities of daily living-Barthel Index (ADL-BI) (SMD: 2.07, 95% CI: 1.06-3.09, P < 0.0001, I2 = 92%), and smaller Chinese stroke scale (CSS) (SMD: -1.10, 95% CI: -1.72 to -0.48, P = 0.0005, I2 = 57%). In view of these findings, we conclude that the outcomes of experimental group are superior to the control group with respect to effectiveness, hematoma volume, ADL-BI, and CSS based on nine RCTs with 611 patients. Atorvastatin is beneficial to CSDH patients without surgery.
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Affiliation(s)
- Bo Wang
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Kangqi Li
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Chenyu Guo
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Zhe Wang
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Weiwei Zhu
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Congxiao Lu
- Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
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Eun J, Ahn S, Lee MH, Choi JG, Kim YI, Cho CB, Park JS. Potential impact of high-density lipoprotein cholesterol in the postoperative outcomes of chronic subdural hematoma patients: multi-institutional study in Korea. Lipids Health Dis 2023; 22:197. [PMID: 37978499 PMCID: PMC10655259 DOI: 10.1186/s12944-023-01970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common clinical situation in neurosurgical practice, but the optimal treatment option is controversial. This study aimed to evaluate the effect of cholesterol-lowering medications on and how they affected the prognoses of CSDH patients. METHODS In this multi-institutional observational study performed in Korea, data from recently treated CSDH patients were gathered from 5 hospitals. A total of 462 patients were collected from March 2010 to June 2021. Patient clinical characteristics, history of underlying diseases and their treatments, radiologic features, and surgical outcomes were analyzed. RESULTS Seventy-five patients experienced recurrences, and 62 had reoperations after the initial burr hole surgery. Among these, 15 patients with recurrences and 12 with reoperations were taking cholesterol-lowering medications. However, the use of medications did not significantly affect recurrence or reoperation rates (P = 0.350, P = 0.336, respectively). When analyzed by type of medication, no clinically relevant differences in total cholesterol (TC), triglyceride (TG), or low-density lipoprotein cholesterol (LDL-C) levels were identified. The combination of a statin drug and ezetimibe significantly elevated high-density lipoprotein cholesterol (HDL-C) levels (P = 0.004). TC, LDL-C, and TG levels did not significantly affect patient prognoses. However, HDL-C levels and recurrence (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.94-0.99; p = 0.010) were negatively correlated. An HDL-C level of 42.50 mg/dL was identified as the threshold for recurrence and reoperation. CONCLUSIONS In this study, using cholesterol-lowering medications did not significantly impact the prognosis of patients who underwent surgical management for a chronic subdural hematoma. However, the findings showed that the higher the HDL-C level, the lower the probability of recurrence and reoperation.
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Affiliation(s)
- Jin Eun
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Stephen Ahn
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Ho Lee
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Gyu Choi
- Department of Neurosurgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Bum Cho
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Gao C, Wei Y, Zhang X, Huang J, Nie M, Liu X, Yuan J, Wang D, Tian Y, Jiang W, An S, Sun J, Sha Z, Fan Y, Feng J, Liu M, Dong S, Wu D, Zhang J, Wang J, Jiang R. Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma. Transl Stroke Res 2023; 14:667-677. [PMID: 35907128 DOI: 10.1007/s12975-022-01062-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
The objective of this study is to explore whether craniocervical manual lymphatic drainage (cMLD) can promote hematoma absorption and increase the efficiency of atorvastatin-based conservative treatment in chronic subdural hematoma (CSDH) patients. All CSDH patients treated with atorvastatin-based therapy between October 2020 and February 2022 in our department were retrospectively screened for enrollment. The patients were divided into the control and cMLD groups according to whether cMLD was performed. Head CT or MR images in both groups were obtained before the treatment and 2 weeks and 4 weeks after the treatment. MR images of the deep cervical lymphatic nodes (dCLNs) in 23 patients were obtained in the cMLD group before and approximately 2 weeks after treatment. The volumes of the dCLNs and hematoma were calculated. The primary outcomes are the differences in hematoma volume reduction after 4 weeks of treatment. The secondary outcomes were (1) the differences in hematoma volume reduction between the patients in these two groups in the 2nd week, (2) the dCLN volume change in the cMLD group before and after 2 weeks of treatment, and (3) the percentage of patients who transitioned to surgery because of failure to the conservative treatment. A total of 106 consecutive patients were enrolled in this study for analysis; 54 patients received atorvastatin-based treatment (control group), and 52 were treated with both atorvastatin-based treatment and cMLD (cMLD group). At baseline, the mean hematoma volume was 76.53 ± 42.97 ml in the control group and 88.57 ± 49.01 ml in the cMLD group (p = 0.181). In the 4th week, the absolute number of hematoma reductions (20.79 ± 34.73 ml vs. 37.28 ± 28.24 ml, p = 0.009) and percentage of hematoma reductions (22.58% ± 60.01% vs. 46.43% ± 30.12%, p = 0.012) in the cMLD group were greater than those in the control group. After 2 weeks of treatment, the absolute number of hematoma reductions showed no difference in the two groups, while the percentage of hematoma reduction was higher in the cMLD group (18.18% ± 24.61% vs. 2.08% ± 25.72%, p = 0.001). One patient in cMLD and 8 patients in the control group were transitioned to receive surgical treatment. The dCLN volumes in 23 experimental patients increased significantly after 2 weeks of treatment in the cMLD group (p = 0.032). There were no severe side effects that needed to be reported. Combined with atorvastatin-based therapy, cMLD can promote hematoma absorption and decrease the surgery rate, which provides a new therapeutic strategy for CSDH.
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Affiliation(s)
- Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Mingqi Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Di Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
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Xu W, Tang X, Liu S, Li Q, Yang F. Efficacy of atorvastatin administration after surgery in patients with chronic subdural hematoma. Medicine (Baltimore) 2023; 102:e35379. [PMID: 37773816 PMCID: PMC10545255 DOI: 10.1097/md.0000000000035379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
To explore the clinical efficacy of atorvastatin administration after surgery in patients with chronic subdural hematoma. We conducted a retrospective study to analyze the clinical data of patients with chronic subdural hematoma. Patients receiving atorvastatin treatment after surgery were divided into the study group while others were divided into the control group. As the primary outcome, we compared the hematoma recurrence rate. The secondary outcomes were the remaining volume of hematoma and the activities of daily living (Barthel index) score at 3 months after discharge. A total of 53 patients were included in the study: 30 patients in the study group (n = 30) and 23 patients in the control group (n = 23). The baseline clinical data were similar in the 2 groups (P > .05). Four patients had recurrence of hematoma in the study group, while 5 patients had recurrence of hematoma in the control group [4/30 (13.3%) versus 5/23 (21.7%), P = .661] at 3 months after discharge. The mean remaining volume of hematoma was 12.10 ± 8.80 mL in the study group and 17.30 ± 9.50 mL in the control group at 3 months after discharge, respectively. The remaining volume of hematoma in the study group was less than that in the control group (P = .045).The activities of daily living score in the study group were higher than those in the control group (97.83 ± 4.48 vs 94.78 ± 5.73, P = .034) at 3 months after discharge. Atorvastatin administration after surgery barely reduce the recurrence rate of chronic subdural hematoma, however, reduced the remaining volume of hematoma and improved neurological function.
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Affiliation(s)
- Wuhuan Xu
- Department of Neurology, Santai hospital affiliated to North Sichuan Medical College, Mianyang, Sichuan, P.R. China
| | - Xielin Tang
- Department of Neurosurgery, Santai hospital affiliated to North Sichuan Medical College, Mianyang, Sichuan, P.R. China
| | - Shenghua Liu
- Department of Neurosurgery, Santai hospital affiliated to North Sichuan Medical College, Mianyang, Sichuan, P.R. China
| | - Qianke Li
- Department of Neurosurgery, Santai hospital affiliated to North Sichuan Medical College, Mianyang, Sichuan, P.R. China
| | - Feilong Yang
- Department of Neurosurgery, Santai hospital affiliated to North Sichuan Medical College, Mianyang, Sichuan, P.R. China
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Foppen M, Bandral HV, Slot KAM, Vandertop WP, Verbaan D. Success of conservative therapy for chronic subdural hematoma patients: a systematic review. Front Neurol 2023; 14:1249332. [PMID: 37780712 PMCID: PMC10540204 DOI: 10.3389/fneur.2023.1249332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Conservative therapy for chronic subdural hematoma (cSDH) is an option for patients who express no, or only mild symptoms, thereby preventing surgery in some. Because it is not clear for whom conservative therapy is successful, we aimed to estimate the success rate of conservative therapy and to identify which factors might influence success. Methods We systematically searched MEDLINE and EMBASE databases to identify all available publications reporting outcome of conservative therapy for cSDH patients. Studies containing >10 patients were included. The primary outcome was the success rate of conservative therapy, defined as "no crossover to surgery" during follow-up. In addition, factors possibly associated with success of conservative therapy were explored. Bias assessment was performed with the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. We calculated pooled incidence and mean estimates, along with their 95% confidence intervals (CIs), using OpenMeta[Analyst] software. Results The search yielded 1,570 articles, of which 11 were included in this study, describing 1,019 conservatively treated patients. The pooled success rate of conservative therapy was 66% (95% CI: 50-82%). One study (n = 98) reported smaller hematoma volume to be associated with success, whilst another study (n = 53) reported low hematoma density and absence of paresis at diagnosis to be associated with success. Conclusion Conservative therapy is reported to be successful in the majority of cSDH patients who have either no, or only mild symptoms. Hematoma volume, low hematoma density and absence of paresis could be factors associated with success. However, further research is warranted in order to establish factors consistently associated with a successful conservative therapy. Other No funding was acquired for this study. The study was not registered nor was a study protocol prepared.
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Affiliation(s)
- M. Foppen
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - Harssh Verdan Bandral
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - Kari-Anne Mariam Slot
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - W. P. Vandertop
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
| | - D. Verbaan
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, Netherlands
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Park YH, Kim KR, Kim KH. Endoscopic Treatment of Chronic Subdural Hematoma Combined with Inner Subdural Hygroma. J Korean Neurosurg Soc 2023; 66:552-561. [PMID: 37332256 PMCID: PMC10483162 DOI: 10.3340/jkns.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present six cases of CSDH combined with ISH treated via endoscopy. METHODS Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, six patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH. RESULTS The mean age of patients was 71 years (range, 66 to 79). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tense and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications. CONCLUSION CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.
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Affiliation(s)
- Yoon Hwan Park
- Department of Neurosurgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ki Hong Kim
- Department of Neurosurgery, Daegu Catholic University College of Medicine, Daegu, Korea
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Bumpetch D, Sitthinamsuwan B, Nunta-aree S. A Prospective Study of the Effect and Safety of Atorvastatin on the Recurrence of Chronic Subdural Hematoma after Burr Hole Surgery. Asian J Neurosurg 2023; 18:567-572. [PMID: 38152511 PMCID: PMC10749861 DOI: 10.1055/s-0043-1771372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Recent studies showed efficacy of atorvastatin in reducing the requirement of surgical treatment. This study aimed to evaluate the efficacy and safety of atorvastatin in reducing the recurrence of CSDH after burr hole surgery. Methods This prospective study included patients with CSDH who underwent burr hole surgery. Atorvastatin at 20 mg per day was administered to all patients for 4 weeks postoperatively. The major outcome was the recurrence rate of CSDH at 8 weeks following the operation. Results Seventy-three patients who completed the 4-week course of atorvastatin were included. The mean age was 73.9 years. The most common cause of CSDH was falling. The mean hematoma volume was 106.3 mL. There was no adverse effect of atorvastatin in all of 73 patients. During the 8-week postoperative period, recurrent CSDH was found in 2 of 73 (2.7%) patients. In a comparison of the recurrence rate of CSDH between patients with use of atorvastatin from the present and previous studies (2.6-4.8%), and patients without use of atorvastatin from previous studies (9.8-19%), a marked reduction in recurrent CSDH after burr hole surgery was found in patients with use of atorvastatin. Conclusion An administration of atorvastatin of 20 mg daily for 4 weeks following burr hole surgery is safe and may be helpful in reducing the recurrence rate of CSDH after burr hole surgery.
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Affiliation(s)
- Duangkamol Bumpetch
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Nan Hospital, Nan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarun Nunta-aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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10
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Wang XJ, Yin YH, Wang ZF, Zhang Y, Sun C, Cui ZM. Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma: An observational study. World J Clin Cases 2022; 10:12920-12927. [PMID: 36568991 PMCID: PMC9782954 DOI: 10.12998/wjcc.v10.i35.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/01/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. The traditional treatment methods include burr hole drainage, bone flap craniectomy and other surgical methods, and there are certain complications such as recurrence, pneumocephalus, infection and so on. With the promotion of neuroendoscopic technology, its treatment effect and advantages need to be further evaluated.
AIM To study the clinical effect of endoscopic small-bone approach in CSDH.
METHODS A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method: the neuroendoscopy group (n = 61 cases) and the burr hole drainage group (n = 61 cases). The clinical treatment effect of the two groups of patients with CSDH was compared.
RESULTS At the early postoperative stage (1 d and 3 d), the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete re-expansion was higher in the neuroendoscopy group than in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). No intracranial hematoma, low cranial pressure, tension pneumocephalus or other complications occurred in the neuroendoscopy group.
CONCLUSION The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up. The surgical effect is apparent with few complications and definite curative effect, which is worthy of clinical promotion and application.
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Affiliation(s)
- Xue-Jian Wang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yu-Hua Yin
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Zhi-Feng Wang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yi Zhang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Cheng Sun
- Jiangsu Provincial Key Laboratory of Nerve Regeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhi-Ming Cui
- Department of Orthopedic, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
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11
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Chan DYC, Cheung EYH, Hui KH, Leung CMS, Ng SCP, Mak WK, Wong GKC, Chan TMD, Poon WS. ABC/2 formula for “bedside” postoperative pneumocephalus volume measurement. Chin Neurosurg J 2022; 8:18. [PMID: 35922864 PMCID: PMC9347102 DOI: 10.1186/s41016-022-00287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pneumocephalus is associated with a higher risk of recurrence of chronic subdural hematoma (cSDH). However, there is no verified simple way to measure the pneumocephalus volume at the bedside for daily clinical use. The ABC/2 method was shown to be a simple and reliable technique to estimate volumes of intracranial lesions, such as intracranial hematomas. This study aims to evaluate the accuracy of the ABC/2 formula in estimating volumes of pneumocephalus, as compared to the gold standard with computer-assisted volumetric analysis. Methods A total of 141 postoperative computed tomographic (CT) brain scans of cSDH patients with burr-hole drainage were analysed. Pneumocephalus volume was measured independently by both the ABC/2 formula and the computer-assisted volumetric measurement. For the computer-assisted measurement, the volume of the air was semiautomatically segmented and calculated by computer software. Linear regression was used to determine the correlation between the ABC/2 method and computer-assisted measurement. Results The postoperative pneumocephalus volume after bilateral burr-hole drainage was significantly larger than that of unilateral burr-hole drainage (29.34 ml versus 12.21 ml, p < 0.001). The estimated volumes by the formula ABC/2 significantly correlated to the volumes as measured by the computer-assisted volumetric technique, with r = 0.992 (p < 0.001). The Pearson correlation coefficient is very close to 1, which signifies a very strong positive correlation, and it is statistically significant. Conclusions An excellent correlation is observed between the ABC/2 method and the computer-assisted measurement. This study verified that the ABC/2 method is an accurate and simple “bedside” technique to estimate pneumocephalus volume. • The ABC/2 method is an accurate and simple “bedside” technique to estimate pneumocephalus volume. • The postoperative pneumocephalus volume after bilateral burr-hole drainage was significantly larger than that of unilateral burr-hole drainage (29.34 ml versus 12.21 ml, p < 0.001). • The estimated volumes of pneumocephalus by the formula ABC/2 were significantly correlated to the volumes as measured by the computer-assisted volumetric technique, with r = 0.992 (p < 0.001).
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12
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The Effect of Statins on the Recurrence of Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 166:244-250.e1. [PMID: 35917921 DOI: 10.1016/j.wneu.2022.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Statins have been proposed to improve the resolution of chronic subdural hematoma (cSDH), with conflicting results likely due to underpowered analysis or confounding factors, such as the use of antithrombotic medication. We performed a systematic literature review and meta-analysis to better elucidate the effect of statin therapy on cSDH recurrence. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the number of recurrences requiring surgical evacuation or leading to neurological deterioration was reported and could be extracted separately for patients who did or did not receive statin therapy. RESULTS Seven studies were included, comprising 1359 cSDH patients (statin therapy, 449 vs. non-statin therapy, 910). Age was not different between groups (P = 0.548). The proportion of men was significantly different (statin, 80.1% vs. non-statin, 74.7%; P = 0.02). Use of antithrombotic medication was significantly higher (P = 0.005) in the statin group (11.7%) than in the non-statin group (7.3%). The statin group had a non-significant lower odds of recurrence (odds ratio 0.80, 95% confidence interval 0.35-1.81). In an exploratory data analysis of 4 studies without a difference between groups in antithrombotic medication use, the statin group had significantly lower odds of recurrence (odds ratio 0.29, 95% confidence interval 0.17-0.50). CONCLUSIONS Overall, we found that statin use did not result in lower odds of cSDH recurrence, likely due to a dilution caused by the higher rate of patients on antithrombotic medications in the statin group.
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13
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Catapano JS, Scherschinski L, Rumalla K, Srinivasan VM, Cole TS, Baranoski JF, Lawton MT, Jadhav AP, Ducruet AF, Albuquerque FC. Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without Middle Meningeal Artery Embolization. AJNR Am J Neuroradiol 2022; 43:1148-1151. [PMID: 35863784 PMCID: PMC9575430 DOI: 10.3174/ajnr.a7572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Middle meningeal artery embolization after surgical evacuation of a chronic subdural hematomas is associated with fewer treatment failures than surgical evacuation. We compared emergency department visits within 30 days for patients with chronic subdural hematomas with and without adjunctive middle meningeal artery embolization. MATERIALS AND METHODS All cases of chronic subdural hematoma treated from January 1, 2018, through December 31, 2020, were retrospectively reviewed. Treatment was classified as surgery only or surgery combined with middle meningeal artery embolization. The primary outcome was 30-day emergency department presentation and readmission. RESULTS Of 137 patients who met the study criteria, 28 (20%) underwent surgery combined with middle meningeal artery embolization. Of these 28 patients, 15 (54%) underwent planned middle meningeal artery embolization and 13 (46%) underwent embolization after surgical failure. The mean chronic subdural hematoma size at presentation in the group with surgery only (n = 109, 20.5 [SD, 6.9] mm) was comparable with that in the combined group (n = 28, 18.7 [SD, 4.5] mm; P = .16). A significantly higher percentage of the surgery-only group presented to the emergency department within 30 days compared with the combined group (32 of 109 [29%] versus 2 of 28 [7%] patients; P = .02). No significant difference was found with respect to readmission (16 [15%] versus 1 [4%] patient; P = .11). Nine patients (8%) in the surgery-only group were readmitted for significant reaccumulation or residual subdural hematoma compared with only 1 patient (4%) in the combined group (P = .40). CONCLUSIONS Surgical evacuation combined with middle meningeal artery embolization in patients with chronic subdural hematoma is associated with fewer 30-day emergency department visits compared with surgery alone.
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Affiliation(s)
- J S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - L Scherschinski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - K Rumalla
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - V M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - T S Cole
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - J F Baranoski
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M T Lawton
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A P Jadhav
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - A F Ducruet
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - F C Albuquerque
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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14
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Abdulla E, Rahman R, Rahman S, Rahman MM. Letter to the Editor Regarding “Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma—A Retrospective Study”. World Neurosurg 2022; 164:456. [DOI: 10.1016/j.wneu.2022.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
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15
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Tian Y, Wang D, Zhang X, Wei H, Wei Y, An S, Gao C, Huang J, Sun J, Jiang R, Zhang J. Establishment and validation of a prediction model for self-absorption probability of chronic subdural hematoma. Front Neurol 2022; 13:913495. [PMID: 35937067 PMCID: PMC9355276 DOI: 10.3389/fneur.2022.913495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChronic subdural hematoma (CSDH) is common in elderly people with a clear or occult traumatic brain injury history. Surgery is a traditional method to remove the hematomas, but it carries a significant risk of recurrence and poor outcomes. Non-surgical treatment has been recently considered effective and safe for some patients with CSDH. However, it is a challenge to speculate which part of patients could obtain benefits from non-surgical treatment.ObjectiveTo establish and validate a new prediction model of self-absorption probability with chronic subdural hematoma.MethodThe prediction model was established based on the data from a randomized clinical trial, which enrolled 196 patients with CSDH from February 2014 to November 2015. The following subjects were extracted: demographic characteristics, medical history, hematoma characters in imaging at admission, and clinical assessments. The outcome was self-absorption at the 8th week after admission. A least absolute shrinkage and selection operator (LASSO) regression model was implemented for data dimensionality reduction and feature selection. Multivariable logistic regression was adopted to establish the model, while the experimental results were presented by nomogram. Discrimination, calibration, and clinical usefulness were used to evaluate the performance of the nomogram. A total of 60 consecutive patients were involved in the external validation, which enrolled in a proof-of-concept clinical trial from July 2014 to December 2018.ResultsDiabetes mellitus history, hematoma volume at admission, presence of basal ganglia suppression, presence of septate hematoma, and usage of atorvastatin were the strongest predictors of self-absorption. The model had good discrimination [area under the curve (AUC), 0.713 (95% CI, 0.637–0.788)] and good calibration (p = 0.986). The nomogram in the validation cohort still had good discrimination [AUC, 0.709 (95% CI, 0.574–0.844)] and good calibration (p = 0.441). A decision curve analysis proved that the nomogram was clinically effective.ConclusionsThis prediction model can be used to obtain self-absorption probability in patients with CSDH, assisting in guiding the choice of therapy, whether they undergo non-surgical treatment or surgery.
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Affiliation(s)
- Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Jian Sun
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
- Rongcai Jiang
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin, China
- Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin, China
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin, China
- Jianning Zhang
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Urokinase is safe and effective in reducing recurrence in Chronic Subdural Hematoma after Burr-hole Drainage. World Neurosurg 2022; 164:e1209-e1213. [DOI: 10.1016/j.wneu.2022.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022]
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Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor. GeroScience 2022; 44:1353-1371. [DOI: 10.1007/s11357-022-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
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Yu W, Chen W, Jiang Y, Ma M, Zhang W, Zhang X, Cheng Y. Effectiveness Comparisons of Drug Therapy on Chronic Subdural Hematoma Recurrence: A Bayesian Network Meta-Analysis and Systematic Review. Front Pharmacol 2022; 13:845386. [PMID: 35401183 PMCID: PMC8993499 DOI: 10.3389/fphar.2022.845386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives: We aim to compare the effectiveness of different drug treatments in improving recurrence in patients with chronic subdural hematoma (CSDH). Methods: Eligible randomized controlled trials (RCTs) and prospective trials were searched in PubMed, Cochrane Library, and Embase, from database inception to December 2021. After the available studies following inclusion and exclusion criteria were screened, the main outcome measures were strictly extracted. Taking the random-effects model, dichotomous data were determined and extracted by odds ratio (OR) with 95% credible interval (CrI), and a surface under the cumulative ranking curve (SUCRA) was generated to calculate the ranking probability of comparative effectiveness among each drug intervention. Moreover, we used the node-splitting model to evaluate inconsistency between direct and indirect comparisons of our network meta-analysis (NMA). Funnel plots were used to evaluate publication bias. Results: From the 318 articles found during initial citation screening, 11 RCTs and 3 prospective trials (n = 3,456 participants) were ultimately included in our study. Our NMA results illustrated that atorvastatin + dexamethasone (ATO+DXM) (OR = 0.06, 95% CrI 0.01, 0.89) was the most effective intervention to improve recurrence in patients with CSDH (SUCRA = 89.40%, 95% CrI 0.29, 1.00). Four drug interventions [ATO+DXM (OR = 0.06, 95% CrI 0.01, 0.89), DXM (OR = 0.18, 95% CrI 0.07, 0.41), tranexamic acid (TXA) (OR = 0.26, 95% CrI 0.07, 0.41), and ATO (OR = 0.41, 95% CrI 0.12, 0.90)] achieved statistical significance in improving recurrence in CSDH patients compared with the placebo (PLB) or standard neurosurgical treatment (SNT) group. Conclusion: Our NMA showed that ATO+DXM, DXM, ATO, and TXA had definite efficacy in improving recurrence in CSDH patients. Among them, ATO+DXM is the best intervention for improving recurrence in patients with CSDH in this particular population. Multicenter rigorous designed prospective randomized trials are still needed to evaluate the role of various drug interventions in improving neurological function or outcome. Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299491), identifier (CRD 42022299491).
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Affiliation(s)
| | | | | | | | | | | | - Yuan Cheng
- *Correspondence: Xiaolin Zhang, ; Yuan Cheng,
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19
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Surgery after primary dexamethasone treatment for patients with Chronic Subdural Hematoma - a retrospective study. World Neurosurg 2022; 162:e358-e368. [PMID: 35276391 DOI: 10.1016/j.wneu.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aim to quantify the need for additional surgery in chronic subdural hematoma (CSDH) patients primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. METHOD Data were retrospectively collected from 283 CSDH patients, primarily treated with dexamethasone, in three hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR). RESULTS 283 CSDH patients were included. 146 patients (51.6%) received one dexamethasone course (DXM-group), 30 patients (10.6%) received two dexamethasone courses (DXM-DXM-group) and 107 patients (37.8%) received additional surgery (DXM-SURG-group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared to 1, aOR 2.05; 95% CI 0.90 - 4.65), used statins (aOR 2.09; 95% CI 1.01 - 4.33), a larger midline shift (aOR 1.10 per mm; 95% CI 1.01 - 1.21) and larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09 - 1.23), a bilateral hematoma (aOR 1.85; 95% CI 0.90 - 3.79) and a separated hematoma (as compared to homogeneous, aOR 1.77; 95% CI 0.72 - 4.38). Antithrombotics (aOR 0.45; 95% CI 0.21 - 0.95) and trabecular hematoma (as compared to homogeneous, aOR 0.31; 95% CI 0.12 - 0.77) were associated with a lower likelihood of surgery. CONCLUSION Over a third of CSDH patients primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
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20
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Jiang RC, Wang D, Zhao SG, Wang RZ, Kang DZ, Zhu XG, Zhao ZM, Wei JJ, Huang Y, Qu Y, Sun XC, Ji HM, Jiang XC, Liu JF, De Zhu X, Wang JJ, Tian Y, Gao C, Wei HJ, Zhang S, Quan W, Yue SY, Lei P, Li X, Song LL, Anderson CS, Zhang JN. Atorvastatin combined with dexamethasone in chronic subdural haematoma (ATOCH II): study protocol for a randomized controlled trial. Trials 2021; 22:905. [PMID: 34895306 PMCID: PMC8666019 DOI: 10.1186/s13063-021-05871-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is a common condition in the elderly that often requires neurosurgical management. For small CSDH, evidence has emerged that statins may reduce haematoma volume and improve outcomes, presumably by reducing local inflammation and promoting vascular repair. We wish to extend this evidence in a study that aims to determine the efficacy and safety of atorvastatin combined with low-dose dexamethasone in patients with CSDH. METHODS The second ATorvastatin On Chronic subdural Hematoma (ATOCH-II) study is a multi-centre, randomized, placebo-controlled, double-blind trial which aims to enrol 240 adult patients with a conservative therapeutic indication for CSDH, randomly allocated to standard treatment with atorvastatin 20 mg combined with low-dose dexamethasone (or matching placebos) daily for 28 days, and with 152 days of follow-up. The primary outcome is a composite good outcome defined by any reduction from baseline in haematoma volume and survival free of surgery at 28 days. Secondary outcomes include functional outcome on the modified Rankin scale (mRS) and modified Barthel Index at 28 days, surgical transition and reduction in haematoma volumes at 14, 28 and 90 days. DISCUSSION This multi-centre clinical trial aims to provide high-quality evidence on the efficacy and safety of the combined treatment of atorvastatin and low-dose dexamethasone to reduce inflammation and enhance angiogenesis in CSDH. TRIAL REGISTRATION ChiCTR, ChiCTR1900021659 . Registered on 3 March 2019, http://www.chictr.org.cn/showproj.aspx?proj=36157 .
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Affiliation(s)
- Rong Cai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Shi Guang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Ren Zhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, No. 41 Damucang Street, Xicheng District, Beijing, 100032, People's Republic of China
| | - De Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian Province, 350005, People's Republic of China
| | - Xin Gen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Zong Mao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, Hebei Province, 050000, People's Republic of China
| | - Jun Ji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, No. 41 Damucang Street, Xicheng District, Beijing, 100032, People's Republic of China
| | - Ying Huang
- Department of Neurosurgery, Tianjin Huanhu Hospital, No. 6 Jizhao Road, Tianjin, 300350, People's Republic of China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Second Affiliated Hospital of Air Force Medical University, No. 1 Xinsi Road, Xian, Shanxi Province, 710038, People's Republic of China
| | - Xiao Chuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 630014, People's Republic of China
| | - Hong Ming Ji
- Department of Neurosurgery, Shanxi Provincial People's Hospital, No. 29 Shuangtasi Road, Taiyuan, Shanxi Province, 030012, People's Republic of China
| | - Xiao Chun Jiang
- Department of Neurosurgery, Yejishan Hospital of Wannan Medical College, No. 2 West Zheshan Road, Wuhu, Anhui Province, 241001, People's Republic of China
| | - Jin Fang Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
| | - Xi De Zhu
- Department of Neurosurgery, Linyi People's Hospital, No. 27 Jiefang Road, Linyi, Shandong Province, 276003, People's Republic of China
| | - Jian Jun Wang
- Department of Neurosurgery, Ordos Central Hospital, No. 23 Yijinhuoluo West Street, Ordos, Inner Mongolia Province, 017000, People's Republic of China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Hui Jie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Shu Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Shu Yuan Yue
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Ping Lei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Xian Li
- The George Institute China at Peking University Health Science Center, Beijing, People's Republic of China.,The George Institute for Global Health, Faculty of Medicine, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Li Li Song
- The George Institute China at Peking University Health Science Center, Beijing, People's Republic of China.,The George Institute for Global Health, Faculty of Medicine, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Craig S Anderson
- The George Institute China at Peking University Health Science Center, Beijing, People's Republic of China. .,The George Institute for Global Health, Faculty of Medicine, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia. .,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Jian Ning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, No. 154 Anshan Road, Tianjin, 300052, People's Republic of China.
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21
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Bounajem MT, Campbell RA, Denorme F, Grandhi R. Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions. J Trauma Acute Care Surg 2021; 91:e134-e141. [PMID: 34538825 DOI: 10.1097/ta.0000000000003404] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Chronic subdural hematomas (CSDHs) are an increasingly common pathology encountered in a neurosurgical trauma practice. Although the operative and nonoperative management of CSDH has been studied extensively, the recurrence rate of CSDH remains high, with no significant decrease in recent years. We undertook a detailed assessment of the known pathophysiological mechanisms by which CSDHs recur to improve our ability to treat patients with this disease successfully. In this review of the literature from the PubMed and Scopus databases, we used the search terms "(pathophysiology) AND chronic subdural hematoma [tiab]" to identify pertinent reviews and articles in English. The results demonstrated a complex inflammatory response to subdural blood, which begins with the formation of a collagen neomembrane around the clot itself. Proinflammatory mediators, such as vascular endothelial growth factor, interleukin-6, interleukin-8, tissue necrosis factor α, matrix metalloproteinases, and basic fibroblast growth factor, then contribute to chronic microbleeding by promoting the formation of fragile, leaky blood vessels, and widening of gap junctions of existing vessels. It is evident that the lack of improvement in recurrence rate is due to pathological factors that are not entirely alleviated by simple subdural evacuation. Targeted approaches, such as middle meningeal artery embolization and anti-inflammatory therapies, have become increasingly common and require further prospective analysis to aid in the determination of their efficacy.
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Affiliation(s)
- Michael T Bounajem
- From the Department of Neurosurgery, Clinical Neurosciences Center (M.T.B., R.G.), Molecular Medicine Program (R.A.C., F.D.); and Department of Internal Medicine (R.A.C.), University of Utah, Salt Lake City, Utah
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22
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Zhang J. Expert consensus on drug treatment of chronic subdural hematoma. Chin Neurosurg J 2021; 7:47. [PMID: 34809712 PMCID: PMC8607705 DOI: 10.1186/s41016-021-00263-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33%). Because CSDH is often seen in the elderly, patients are weak and have many basic diseases. The risk of surgical treatment is high; serious complications and even death (the death rate is up to 32%) can often occur. The overall good prognosis rate of patients aged more than 90 years is 24%. The drug treatment can provide a safe and effective treatment for elderly patients who are weak, intolerable to surgery, or failed in surgery. Low-dose and long-term use of atorvastatin (20mg/d) is suggested for continuous treatment for at least 8 weeks, while low-dose and short-term use of dexamethasone can improve the therapeutic effect of atorvastatin on CSDH. Patients should undergo CT or MRI scanning at least one time within 2 weeks after the start of drug treatment.
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Affiliation(s)
- Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, 300052, China. .,Tianjin Neurological Institute, Tianjin, 300052, China.
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23
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Désir LL, D'Amico R, Link T, Silva D, Ellis JA, Doron O, Langer DJ, Ortiz R, Serulle Y. Middle Meningeal Artery Embolization and the Treatment of a Chronic Subdural Hematoma. Cureus 2021; 13:e18868. [PMID: 34754700 PMCID: PMC8570051 DOI: 10.7759/cureus.18868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
Chronic subdural hematoma (cSDH) is a common pathology that typically affects the elderly. It is believed to occur due to injury to the dural border cells, which creates an inflammation/proliferation reaction. Ineffective repair leads to the formation of a new external layer of cells and fragile capillaries, which damage easily and can worsen the condition. Conventionally, asymptomatic cSDH is managed by observation, and symptomatic cases are treated by surgical evacuation. Unfortunately, recurrence rates of the SDH following surgical evacuation can be high. One treatment option for SDH involves embolization of the middle meningeal artery (MMA). The MMA provides blood supply to the dura mater and feeds the membrane capillaries covering the SDH. MMA embolization blocks the blood flow to this system and can promote hematoma resolution. In this paper, we review the existing literature on MMA embolization and discuss the underlying pathophysiology of cSDH.
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Affiliation(s)
- Likowsky L Désir
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Randy D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Thomas Link
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Danilo Silva
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Jason A Ellis
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Omer Doron
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - David J Langer
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Rafael Ortiz
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
| | - Yafell Serulle
- Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA
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24
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Zhang X, Wang D, Tian Y, Wei H, Liu X, Xiang T, Fan Y, Gao C, Huang J, Sha Z, Quan W, Zhang J, Jiang R. Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis. Front Aging Neurosci 2021; 13:726592. [PMID: 34539386 PMCID: PMC8440973 DOI: 10.3389/fnagi.2021.726592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage in the aging population. We aimed to investigate the predictive factors for atorvastatin efficacy as a monotherapy for moderate CSDH. We retrospectively reviewed the medical records of patients who were diagnosed with moderate CSDH and received atorvastatin monotherapy between February 5, 2014, and November 7, 2015, in multiple neurosurgical departments. Univariate, multivariate and receiver operating characteristic curve analyses were performed to identify the potential significant factors indicative of the good therapeutic efficacy or poor therapeutic efficacy of atorvastatin for mild CSDH, such as age, sex, history of injury, Markwalder grading scale–Glasgow Coma Scale (MGS-GCS), Activities of Daily Life-the Barthel Index scale (ADL-BI), American Society of Anesthesiologists Physical Status classification system (ASA-PS), blood cell counts, serum levels and computed tomography findings. A total of 89 patients (75 men and 14 women) aged 24–88 years (mean age 61.95 ± 15.30 years) were followed-up for 24 weeks. Computed tomography findings at admission showed mixed-density hematoma in 22 patients, isodense hematoma in 13 patients, high-density hematoma in 26 patients, and low-density hematoma in 28 patients. In total, 3, 80, and 6 patients had MGS-GCS grades of 0, 1, and 2, respectively. The efficacy rate at 6 months was 87.6% (78/89). Eleven patients were switched to surgery due to a worsened neurological condition, of whom 8, 1, 1, and 1 had high-density, low-density, isodense and mixed-density hematomas, respectively. These patients were switched to surgery over a range of 2–27 days, with a median interval of 12 days after the medication treatment. Univariate and multivariate analyses, confirmed by ROC curves, revealed that high-density hematoma, basal cistern compression, and hematoma volume to be independent risk factors for the efficacy of atorvastatin monotherapy in patients with moderate CSDH. Atorvastatin is an effective monotherapy for the treatment of mild CSDH. High-density hematoma, basal cistern compression, and hematoma volume are independent predictors of the efficacy of atorvastatin as a non-surgical treatment. The results suggested that ADL-BI was more sensitive than the MGS-GCS and ASA-PS for determining patient outcomes in our moderate CSDH cohort.
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Affiliation(s)
- Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
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25
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Gong Z, Zhan D, Nie M, Li X, Gao C, Liu X, Xiang T, Yuan J, Jiang W, Huang J, Quan W, Wang D, Tian Y, Yuan H, Zhang J, Jiang R. Dexamethasone enhances the efficacy of atorvastatin in inhibiting excessively inflammation-induced abnormal angiogenesis by regulating macrophages. J Neuroinflammation 2021; 18:203. [PMID: 34526068 PMCID: PMC8444603 DOI: 10.1186/s12974-021-02257-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have recently showed that atorvastatin (ATO) combined with low dose of dexamethasone (DEX) was more efficacious in treating patients with chronic subdural haematoma (CSDH) than ATO monotherapy. This study was designed to investigate the underlying mechanisms of the improved efficacy of this combined therapy. METHODS Mass spectrometry was performed to quantitatively detect drugs in haematoma fluids and serum samples from CSDH patients and also in cultured macrophages after treatment with either ATO alone or in combination with DEX. The differentiation and apoptosis of macrophages were evaluated using flow cytometry. The expression of cytokines, chemokines and angiogenesis-related proteins was evaluated using proteome profile arrays, immunoblots and ELISA, respectively. RESULTS ATO was detected in haematoma fluids and serum samples, whose levels were increased significantly in samples collected from patients treated with both ATO and DEX. ATO was also increased in cultured macrophages treated with ATO and DEX. The numbers of M1-polarized macrophages were higher than the M2 phenotype in the haematoma fluids of patients. Cultured macrophages treated with ATO and DEX had reduced numbers of M1-polarized macrophages, increased numbers of M2-polarized macrophages as compared to monotherapies, and decreased rate of apoptosis induced by high-dose DEX. DEX enhanced the anti-inflammatory and anti-angiogenic activity of ATO by suppressing VEGFA and other inflammatory angiogenic factors. Consistent with the finding, patients responded well to the drug treatments had lower serum levels of VEGFA. CONCLUSIONS We have shown for the first time that ATO given orally was detected in CSDH haematoma fluids. DEX enhances the anti-inflammatory and anti-angiogenic effects of ATO, primarily by increasing the presence of ATO in haematoma and macrophages and by regulating the functions of macrophages.
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Affiliation(s)
- Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.,Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Daqiang Zhan
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.,Department of pharmacy, Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xiaochun Li
- Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.,Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Hengjie Yuan
- Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China. .,Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. .,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. .,Tianjin Neurological Institute, Key Laboratory of Post-neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.
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26
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Lizana J, Aliaga N, Basurco A. Hematoma subdural crónico: Una patología común de manejo complejo. Surg Neurol Int 2021. [DOI: 10.25259/sni_676_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antecedentes:
El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión.
Métodos:
Los autores revisaron la fisiopatología y características clínicas del HSDC. El presente artículo discute acerca de las terapéuticas actuales y las nuevas opciones de tratamiento que podrían mejorar los resultados. Este manuscrito es susceptible de cambios en el tiempo, con el desarrollo científico y tecnológico.
Resultados:
El HSDC puede ser abordado por vía quirúrgica y farmacológica; no obstante, un manejo individualizado requiere la consideracion cuidadosa de diversos factores. A pesar de los avances en el campo de la neurocirugía, la clásica trepanación craneal sigue siendo el Gold estándar en el HSDC y sobre todo en pacientes con síntomas graves. Se debe resaltar que aún hay aspectos de este procedimiento (como la localización del dren, número de drenajes, el efecto de la irrigación, la temperatura de la solución con que se irriga, etc.) que siguen siendo materia de estudio.
Conclusiones:
Entender el mecanismo de la enfermedad ha permitido explicar su historia natural y a su vez proponer nuevas alternativas de tratamiento. El manejo médico (atorvastatina, corticoides) ha generado gran interés por sus alentadores resultados preliminares. Recientemente, se ha reportado la terapia endovascular como una alternativa segura y existe gran expectativa por confirmar su efecto en estudios más grandes.
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Affiliation(s)
- Jafeth Lizana
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara, Lima, Peru,
| | - Nelida Aliaga
- Department of Medicine, School of Biomedical Sciences, Austral University, Mariano Acosta, Buenos Aires, Argentina
| | - Alfonso Basurco
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara, Lima, Peru,
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27
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Klein J, Mauck L, Schackert G, Pinzer T. Do statins reduce the rate of revision surgery after chronic subdural hematoma drain? Acta Neurochir (Wien) 2021; 163:1843-1848. [PMID: 34036461 PMCID: PMC8195925 DOI: 10.1007/s00701-021-04871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. METHODS We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. RESULTS We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. CONCLUSIONS We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.
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Affiliation(s)
- Johann Klein
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Lisa Mauck
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Pinzer
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Chan DYC, Poon WS, Chan DTM, Mak WK, Wong GKC. Chronic subdural haematoma during the COVID-19 lockdown period: late presentation with a longer interval from the initial head injury to the final presentation and diagnosis. Chin Neurosurg J 2021; 7:4. [PMID: 33419483 PMCID: PMC7791163 DOI: 10.1186/s41016-020-00229-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background The COVID-19 novel coronavirus is contagious, and the mortality is higher in the elderly population. Lockdown in different parts of the world has been imposed since January 2020. Chronic subdural haematoma (cSDH) has a unique natural history in which symptoms can be non-specific, and the onset is insidious. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation of cSDH. Methods Consecutive adult cSDH patients admitted from 1 March 2020 to 30 April 2020 were reviewed. Exclusion criteria including those who had no definite history of head injury or the diagnosis of cSDH were made from a scheduled follow-up scan. Corresponding data during the same period in 2019 were reviewed for comparison. The primary outcome was the interval between the initial head injury and the final radiological diagnosis of cSDH. Secondary outcomes include Markwalder chronic subdural haematoma grade upon admission, length of stay in the acute hospital, and the modified Rankin scale (mRS) upon discharge. Results For the primary outcome, the average interval between head injury and the diagnosis of cSDH was significantly longer at 56.6 days (49 to 74 days, SD 9.83 days) during the period from March to April 2020, versus 29.4 days (17 to 42 days, SD 8.59 days) in 2019 for the corresponding period (p = 0.00703). There was no significant difference in the functional outcome upon discharge. Conclusions cSDH patients can present late during the COVID-19 lockdown period. The functional outcome was comparable when operations for drainage were timely performed.
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Affiliation(s)
- David Yuen Chung Chan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
| | - Danny Tat Ming Chan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wai Kit Mak
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Fan YS, Wang B, Wang D, Xu X, Gao C, Li Y, Zhang S, Yang GL, Liu X, Jiang RC, Zhang JN. Atorvastatin combined with low-dose dexamethasone for vascular endothelial cell dysfunction induced by chronic subdural hematoma. Neural Regen Res 2021; 16:523-530. [PMID: 32985481 PMCID: PMC7996011 DOI: 10.4103/1673-5374.293152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Atorvastatin has been shown to be a safe and effective non-surgical treatment option for patients with chronic subdural hematoma. However, treatment with atorvastatin is not effective in some patients, who must undergo further surgical treatment. Dexamethasone has anti-inflammatory and immunomodulatory effects, and low dosages are safe and effective for the treatment of many diseases, such as ankylosing spondylitis and community-acquired pneumonia. However, the effects of atorvastatin and low-dose dexamethasone for the treatment of chronic subdural hematoma remain poorly understood. Hematoma samples of patients with chronic subdural hematoma admitted to the General Hospital of Tianjin Medical University of China were collected and diluted in endothelial cell medium at 1:1 as the hematoma group. Atorvastatin, dexamethasone, or their combination was added to the culture medium. The main results were as follows: hopping probe ion conductance microscopy and permeability detection revealed that the best dosages to improve endothelial cell permeability were 0.1 μM atorvastatin and 0.1 μM dexamethasone. Atorvastatin, dexamethasone, or their combination could markedly improve the recovery of injured endothelial cells. Mice subcutaneously injected with diluted hematoma solution and then treated with atorvastatin, dexamethasone, or their combination exhibited varying levels of rescue of endothelial cell function. Hopping probe ion conductance microscopy, western blot assay, and polymerase chain reaction to evaluate the status of human cerebral endothelial cell status and expression level of tight junction protein indicated that atorvastatin, dexamethasone, or their combination could reduce subcutaneous vascular leakage caused by hematoma fluid. Moreover, the curative effect of the combined treatment was significantly better than that of either single treatment. Expression of Krüppel-like factor 2 protein in human cerebral endothelial cells was significantly increased, as was expression of the tight junction protein and vascular permeability marker vascular endothelial cadherin in each treatment group compared with the hematoma stimulation group. Hematoma fluid in patients with chronic subdural hematoma may damage vascular endothelial cells. However, atorvastatin combined with low-dose dexamethasone could rescue endothelial cell dysfunction by increasing the expression of tight junction proteins after hematoma injury. The effect of combining atorvastatin with low-dose dexamethasone was better than that of atorvastatin alone. Increased expression of Krüppel-like factor 2 may play an important role in the treatment of chronic subdural hematoma. The animal protocols were approved by the Animal Care and Use Committee of Tianjin Medical University of China on July 31, 2016 (approval No. IRB2016-YX-036). The study regarding human hematoma samples was approved by the Ethics Committee of Tianjin Medical University of China on July 31, 2018 (approval No. IRB2018-088-01).
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Affiliation(s)
- Yue-Shan Fan
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City; Graduate School, Tianjin Medical University, Tianjin, China
| | - Bo Wang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City; Graduate School, Tianjin Medical University, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City; Graduate School, Tianjin Medical University, Tianjin, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuang Gao
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Ying Li
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Shu Zhang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Gui-Li Yang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Xiao Liu
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Rong-Cai Jiang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jian-Ning Zhang
- Department of Neurosurgery, General Hospital of Tianjin Medical University; Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
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Wang D, Gao C, Xu X, Chen T, Tian Y, Wei H, Zhang S, Quan W, Wang Y, Yue S, Wang Z, Lei P, Anderson C, Dong J, Zhang J, Jiang R. Treatment of chronic subdural hematoma with atorvastatin combined with low-dose dexamethasone: phase II randomized proof-of-concept clinical trial. J Neurosurg 2021; 134:235-243. [PMID: 32005012 DOI: 10.3171/2019.11.jns192020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to test the hypothesis that adding dexamethasone (DXM) to atorvastatin (ATO) potentiates the effects of ATO on chronic subdural hematoma (CSDH). METHODS Sixty patients with CSDH underwent 5 weeks of treatment with an additional 7-week follow-up. Patients were randomized to receive a 5-week regimen of ATO 20 mg daily or ATO 20 mg daily plus a DXM regimen (ATO+DXM). The 5-week DXM regimen was 2.25 mg daily for 2 consecutive weeks, followed by 0.75 mg twice daily for 2 weeks and 0.75 mg once daily for 1 week. The primary endpoint was hematoma reduction assessed by neuroimaging at baseline and at 5 weeks of follow-up. Secondary outcomes included neurological improvement assessed by using the Markwalder's Grading Scale and Glasgow Coma Scale (MGS-GCS). RESULTS The mean patient age was 66.6 years, and 25% of patients were women. The patients who were treated with ATO+DXM had more obvious hematoma reduction at the 5th week (between-groups difference 18.37 ml; 95% CI 8.17-28.57; p = 0.0005). This reduction started from the 2nd week (14.51 ml; 95% CI 4.31-24.71; p = 0.0056) of treatment and persisted until the 12th week (17.50 ml; 95% CI 7.30-27.70; p = 0.0009). Complete recovery of neurological function (MGS-GCS grade 0) at 5 weeks was achieved in 83.33% and 32.14% of patients in the ATO+DXM and ATO groups, respectively. At the 5th week, patients receiving ATO+DXM had significantly lower levels of T cells and higher levels of regulatory T cells and endothelial progenitor cells in their peripheral blood. CONCLUSIONS ATO+DXM was more effective than ATO alone in reducing hematoma and improving neurological function in patients with CSDH. These results require further confirmation in a randomized placebo-controlled trial.Clinical trial registration no.: ChiCTR-IPR-14005573 (http://www.chictr.org.cn/index.aspx).
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Affiliation(s)
- Dong Wang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Chuang Gao
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Xin Xu
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Tao Chen
- 3Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ye Tian
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Huijie Wei
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Shu Zhang
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Wei Quan
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Yi Wang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Shuyuan Yue
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Zengguang Wang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Ping Lei
- 4Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Craig Anderson
- 5George Institute China at Peking University Health Science Center China and George Institute for International Health, University of Sydney, Australia; and
| | - Jingfei Dong
- 6Bloodworks Research Institute, Bloodworks Northwest and Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jianning Zhang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Rongcai Jiang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin
- 2Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Ministry of Education, Tianjin Medical University, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Tianjin, China
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Yun HJ, Ding Y. How to remove those bloody collections: Nonsurgical treatment options for chronic subdural hematoma. Brain Circ 2020; 6:254-259. [PMID: 33506148 PMCID: PMC7821810 DOI: 10.4103/bc.bc_73_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is one of the most prevalent neurosurgical disorders. Patients with CSDH commonly present with altered mental status, focal neurological deficit, and/or headache. The first-line treatment for CSDH is surgical evacuation. Although the surgical procedures for CSDH have been considered relatively “straightforward,” they are not without any risk. The elderly are especially prone to show poor surgical outcomes. To make matters worse, many elderly patients are on anticoagulants and antiplatelet agents, increasing the risk of re-bleeding before and after surgery. These complications have led clinicians to search for nonsurgical alternatives. Dexamethasone should be used with caution for selected patients given its side effects. Tranexamic acid may be utilized as an adjunct therapy to surgery, but more randomized clinical trials are needed to evaluate its definitive efficacy. Interesting results of middle meningeal artery embolization (MMAE) have been reported from case studies. However, the risks associated with MMAE, including intracerebral hemorrhage, stroke, and vasospasm, have not been properly studied yet. The clinical benefits of atorvastatin and angiotensin-converting enzyme inhibitors are uncertain for CSDH. In conclusion, surgical intervention continues to be the first-line treatment while nonsurgical treatment options may be considered an adjunct therapy especially for recurrent hematoma or to reduce the volume of a hematoma.
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Affiliation(s)
- Ho Jun Yun
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Prediction Models for Recurrence of Chronic Subdural Hematoma in Patients Underwent Twist-Drill Craniostomy Combined With Urokinase Instillation. J Craniofac Surg 2020; 31:2267-2272. [PMID: 33136868 DOI: 10.1097/scs.0000000000006779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The recurrence of chronic subdural hematoma (CSDH) is high post-treatment. In this study, we aimed to construct individualized models for prediction of the postoperative recurrence of CSDH in patients underwent twist-drill craniostomy combined with urokinase (UK) instillation. In total, 183 patients with CSDH were retrospectively enrolled. In summary, 21 candidate factors were retrieved from past medical records. The least absolute shrinkage and selection operator regression was adopted to reduce the high dimensionality of data. Four predictors: preoperative hematoma volume, encephalatrophy, brain re-expansion, and UK instillation frequency were filtered from the 21 candidate factors using the least absolute shrinkage and selection operator method. Binary logistic regression model was employed to establish preoperative and postoperative prediction models. The preoperative model included preoperative hematoma volume and encephalatrophy whereas the postoperative model included brain re-expansion and UK instillation frequency. The predictive performance of the nomograms was evaluated by the receiver operating characteristic curve and calibration chart. Area under curve of the preoperative and postoperative models were 0.755 (95% confidence interval: 0.690-0.889) and 0.782 (95% confidence interval: 0.720-0.936), respectively, indicating good discrimination ability. The calibration results showed good fitting between the predicted probability and the actual probability. Finally, a decision curve analysis revealed excellent clinical performance of the proposed nomograms. Functionally, the preoperative model was used to identify high-risk patients with CSDH and application of UK, while the postoperative model was applied to guide physician-patients communication during follow-up. These 2 prediction models provide a basis for further clinical and experimental studies.
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Catapano JS, Nguyen CL, Wakim AA, Albuquerque FC, Ducruet AF. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Front Neurol 2020; 11:557233. [PMID: 33192990 PMCID: PMC7606850 DOI: 10.3389/fneur.2020.557233] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023] Open
Abstract
Chronic subdural hematoma (cSDH) is a common disease process associated with significant morbidity that occurs most often in elderly patients. Asymptomatic patients are typically treated conservatively, with surgical intervention reserved for patients with symptomatic and/or large hematomas that cause brain compression. However, conservatively managed cSDH cases frequently progress, and surgical evacuation of cSDH is associated with high rates of complication and recurrence. Recently, successful treatment of cSDH via middle meningeal artery (MMA) embolization has been reported in small case series and case reports. This article reviews the existing literature on MMA embolization for cSDH and discusses the need for randomized control trials and/or large prospective studies to establish the efficacy of MMA embolization for this disease.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Candice L Nguyen
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Andre A Wakim
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
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Xu M, Wang WH, Zhu SQ, Tan WG, Jin XG, Lu W, Chen L. Effects of minimally invasive approaches on chronic subdural hematoma by novel YL-1 puncture needle and burr-hole methods. Acta Neurol Belg 2020; 120:37-42. [PMID: 29623601 DOI: 10.1007/s13760-018-0914-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
Abstract
The objective of this study is to investigate effects of minimally invasive approaches on outcome of chronic subdural hematoma (CSDH) by novel YL-1 puncture needle and burr-hole methods. A retrospective analysis was performed in 158 hospitalized CSDH patients from January, 2013 to December, 2017 in Kunshan Hospital of Traditional Chinese Medicine. Patients' gender, age, history of trauma, volume of hematoma, hematoma location, application of urokinase, surgical approach, the operation time, hospitalized time, and CT scans 3 months after discharge were recorded. Prognostic indicators including symptom relief and post-hospital neuro-imaging findings were extracted to evaluate surgical efficacy. Statistical methods were conducted to evaluate surgical efficacy. Both YL-1 puncture needle and burr-hole surgeries had a satisfying follow-up (93.67%). There was non-significant group difference in follow-up results (p > 0.05). While YL-1 needle group needs less operation time ((p < 0.001) and hospitalized time (p < 0.001), gender (p = 0.144), age (p = 0.394), history of head trauma (p = 0.445), volume of hematoma (p = 0.068), hematoma location (p = 0.281), and application of urokinase (p = 0.545) were shown non-significantly associated with these two minimally invasive approaches. Volume of hematoma was significantly associated with follow-up outcomes (p = 0.016). Novel YL-1 puncture needle and classic burr-hole craniotomy are both proved to be safe and effective minimally invasive surgeries, which can provide an early intervention and minimally invasive strategy for neurosurgeons.
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Affiliation(s)
- Min Xu
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Wen-Hua Wang
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Sheng-Qiang Zhu
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Wei-Guo Tan
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Xue-Gang Jin
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Wei Lu
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Long Chen
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China.
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Du B, Xu J, Hu J, Zhong X, Liang J, Lei P, Wang H, Li W, Peng Y, Shan A, Zhang Y. A Clinical Study of the Intra-Neuroendoscopic Technique for the Treatment of Subacute-Chronic and Chronic Septal Subdural Hematoma. Front Neurol 2020; 10:1408. [PMID: 32010057 PMCID: PMC6979069 DOI: 10.3389/fneur.2019.01408] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: The surgical technique, safety, efficacy, and clinical application value of the intra-neuroendoscopic technique (INET) for the treatment of subacute-chronic and chronic septal subdural hematoma was investigated based on the structure and pathological features of the hematoma wall, and the critical factors of hematoma growth and recurrence were determined, in order to provide reference for clinical drug treatment. Methods: This was non-randomized concurrent control study. A total of 94 patients who met the inclusion criteria were recruited between May 2015 and February 2019 and were divided into the INET treatment group (INET group, 45 cases) and the burr hole drainage (BHD) treatment group (control group, 49 cases). The hematoma fluid components and the morphological structure and pathological characteristics of the hematoma wall were analyzed, and the surgical duration, subdural drainage tube (SDT) placement duration, intracranial infection rate, Bender grade at the 1 month post-operative follow-up and hematoma recurrence rate within the 6 months of post-operative follow-up were compared between the two groups. A multiple logistic regression model was established to analyze the risk factors associated with recurrence within 6 months. Results: Intraoperative endoscopy showed that the adhesion bands that formed early in the hematoma cavity were strip-like and that those that formed late were lock-column-like. The hematoma cavity was divided into different-sized chambers with by these strips/columns. Pathological sections of cyst wall reveled angiogenesis inside the cyst and mucus-like changes, rupture and hemorrhage in the vascular wall. Obvious inflammatory cell infiltration and fibrous connective tissue hyperplasia were observed in the cyst wall. The osmotic pressure of the hematoma fluid was not significantly different from that of the peripheral venous blood [(296.7 ± 10.3) mOsm/kg vs. (291.5 ± 12.4) mOsm/kg, p = 0.68]. However, the D-dimer contents which reflect the severity of fibrinolysis in the hematoma and the proinflammatory cytokine interleukin 6 (IL-6) were significantly higher in the hematoma fluid than in the peripheral venous blood. The surgery duration for the INET group was significantly longer than that for the control group [(60.4 ± 10.6) min vs. (44.1 ± 9.8) min, p = 0.00], but both the hematoma recurrence rate within 6 months of post-operative follow-up (4.4 vs. 24.5%, p = 0.00) and the SDT placement duration [(2.1 ± 0.6) d vs. (3.9 ± 0.7) d, p = 0.00] for the INET group were both lower than those for the control group. The intracranial infection rate did not differ significantly between the two groups (4.4 vs. 10.2%, p = 0.50). The overall effective rate of the Bender grade at 1 month of follow-up did not differ significantly between the two groups (95.6 vs. 87.8%, p = 0.32), but the proportion of patients who recovered to Bender grade 0 with no symptoms was significantly higher in the INET group than in the control group (86.7 vs. 67.3%, p = 0.03). Multiple logistic regression analysis showed that INET surgery [odds ratio (OR) 3.71, 95% confidence interval (CI) 1.31–9.62, p = 0.02], age of 65 years or younger (OR 1.51, 95% CI 1.05–2.87, p = 0.03) and unilateral subdural hematoma (OR 1.76, 95% CI 1.05–3.41, p = 0.02) were independent factors that reduced the post-operative recurrence rate. Conclusion: The INET surgical plan based on the structure and pathological features of the subacute-chronic and chronic subdural hematoma wall can reduce the recurrence rate and improve the clinical prognosis. Trial registration:ClinicalTrials.gov, NCT02515903. Registered 5 August, 2015.
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Affiliation(s)
- Bo Du
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jianzhong Xu
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jintao Hu
- Department of Pathology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xianliang Zhong
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jian Liang
- Department of Neurosurgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Pengfei Lei
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hao Wang
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Weichun Li
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Yuping Peng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aijun Shan
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Yujuan Zhang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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He C, Xia P, Xu J, Chen L, Zhang Q. Evaluation of the efficacy of atorvastatin in the treatment for chronic subdural hematoma: a meta-analysis. Neurosurg Rev 2020; 44:479-484. [PMID: 31953781 DOI: 10.1007/s10143-019-01218-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022]
Abstract
Atorvastatin therapy in chronic subdural hematoma patients has attracted more and more clinical attention. To evaluate the efficacy of atorvastatin in the treatment of chronic subdural hematoma. A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases; related controlled trials comparing the efficacy of atorvastatin in the treatment of chronic subdural hematoma published from inception to December 2018 were collected. We used Cochrane risk of bias method to evaluate the quality of the included studies. Meta-analysis was used to analyze the included data by RevMan 5.3 software. Of the 53 retrieved studies, 6 trials were included. Results of meta-analysis showed that compared with chronic subdural hematoma patients without atorvastatin treatment, both in patients who have had surgery and those who have not, atorvastatin were effective in reducing the incidence of recurrence requires surgery (OR = 0.30, 95% CI 0.19-0.48, P < 0.00001). And improve the recovery rate of neurological function of patients (OR = 1.75, 95% CI 1.08-2.83, P = 0.02). This meta-analysis suggests that patients with chronic subdural hematoma can improve their prognosis after receiving atorvastatin. Additionally, the neurological function recovery appears to be improving by atorvastatin.
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Affiliation(s)
- Chang He
- Department of Genetics, College of Basic Medical Sciences, Jilin University, Changchun, China.,Department of Molecular Biology, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Pengfei Xia
- Department of Neurosurgery, The Second Clinical Medical School of Inner Mongolia University for the Nationalities, Hulun Buir, China
| | - Jinying Xu
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Lanlan Chen
- Clinical Medicine of Jilin University, Changchun, China
| | - Qiuli Zhang
- Department of Ophthalmology, affiliated Hospital of Guangdong Medical University, Zhanjiang, China. .,Guangdong Medical University, Zhanjiang, China.
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Quan W, Zhang Z, Li P, Tian Q, Huang J, Qian Y, Gao C, Su W, Wang Z, Zhang J, Zacharek A, Venkat P, Chen J, Jiang R. Role of Regulatory T cells in Atorvastatin Induced Absorption of Chronic Subdural Hematoma in Rats. Aging Dis 2019; 10:992-1002. [PMID: 31595197 PMCID: PMC6764728 DOI: 10.14336/ad.2018.0926] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/26/2018] [Indexed: 12/11/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a neurological disorder with a substantial recurrence rate. Atorvastatin is an effective drug for treating hyperlipidemia and known to improve neurological outcome after intracerebral hemorrhage. Previous studies have reported that atorvastatin treatment promotes hematoma absorption in CSDH, while the underlying mechanisms remain unclear. In this study, we investigated whether the anti-inflammatory effects of atorvastatin mediate absorption of CSDH. 144 male, Wistar rats (6 months old) were randomly divided into the following groups: 1) sham surgery control, 2) treatment: CSDH + atorvastatin, and 3) vehicle control: CSDH + saline. Atorvastatin or saline was orally administered daily for 19 days after CSDH procedure. A T2WI MRI was used to evaluate CSDH volume changes during the time course of the study. Flow cytometry and immunohistochemical staining were used to measure the number of regulatory T cells (Treg). ELISA was used to measure cytokine level in the hematoma border. Neurological function and cognitive outcome were evaluated using Foot-Fault test and Morris Water Maze test, respectively. When compared to saline treatment, atorvastatin treatment accelerated the absorption of CSDH as indicated by decreased hematoma volume in T2WI MRI data on 14th and 21st day after CSDH (P<0.05). Atorvastatin treatment significantly increased the number of Treg in circulation and hematoma border from 3rd to 21st day after CSDH. Atorvastatin treatment significantly decreased the levels of interleukins (IL-6 and IL-8) and tumor necrosis factor-α (TNF-α), but increased IL-10 level in the hematoma border. Atorvastatin treatment also improved neurological function and cognitive outcome compared to vehicle treated group. Atorvastatin induced anti-inflammatory responses and increased Treg in circulation and brain which may contribute to the accelerated CSDH absorption in rats.
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Affiliation(s)
- Wei Quan
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Zhifei Zhang
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China.,3Department of Neurosurgery, The First Central Hospital of Tianjin, Tianjin, China
| | - Pan Li
- 4Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Qilong Tian
- 5Department of Neurology, Tangdu Hospital, Baqiao, Shanxi, China
| | - Jinhao Huang
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Yu Qian
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Chuang Gao
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Wanqiang Su
- 6Department of Neurosurgery, The First Central Hospital of Baoding City, Lianchi, Baoding, China
| | - Zengguang Wang
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Jianning Zhang
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China.,2Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China
| | - Alex Zacharek
- 7Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Poornima Venkat
- 7Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Jieli Chen
- 7Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Rongcai Jiang
- 1Department of Neurosurgery, General Hospital of Tianjin Medical University, Tianjin, China
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Feng Z, Chen Z. Letter: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases. Neurosurgery 2019; 85:E394. [DOI: 10.1093/neuros/nyz137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/18/2019] [Indexed: 11/13/2022] Open
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Redelmeier DA, Manzoor F, Thiruchelvam D. Association Between Statin Use and Risk of Dementia After a Concussion. JAMA Neurol 2019; 76:887-896. [PMID: 31107515 DOI: 10.1001/jamaneurol.2019.1148] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery. Objective To test whether statin use is associated with an increased or decreased risk of subsequent dementia after a concussion. Design, Setting, and Participants Large extended population-based double cohort study in Ontario, Canada, from April 1, 1993, to April 1, 2013 (enrollment), and continued until March 31, 2016 (follow-up). Dates of analysis were April 28, 2014, through March 21, 2019. Participants were older adults diagnosed as having a concussion, excluding severe cases resulting in hospitalization, individuals with a prior diagnosis of dementia or delirium, and those who died within 90 days. Exposure Statin prescription within 90 days after a concussion. Main Outcome and Measure Long-term incidence of dementia. Results This study identified 28 815 patients diagnosed as having a concussion (median age, 76 years; 61.3% female), of whom 7058 (24.5%) received a statin, and 21 757 (75.5%) did not receive a statin. A total of 4727 patients subsequently developed dementia over a mean follow-up of 3.9 years, equal to an incidence of 1 case per 6 patients. Patients who received a statin had a 13% reduced risk of dementia compared with patients who did not receive a statin (relative risk, 0.87; 95% CI, 0.81-0.93; P < .001). The decreased risk of dementia associated with statin use applied to diverse patient groups, remained independent of other cardiovascular medication use, intensified over time, was distinct from the risk of subsequent depression, and was not observed in patients after an ankle sprain. Conclusions and Relevance In this study, older adults had a substantial long-term risk of dementia after a concussion, which was associated with a modest reduction among patients receiving a statin.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Center for Leading Injury Prevention Practice Education & Research, Toronto, Ontario, Canada
| | - Fizza Manzoor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada
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40
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Efficacy analysis of flexible neuroendoscopy combined with dry-field techniques in the treatment of chronic subdural hematoma. Chin Med J (Engl) 2019; 132:1359-1362. [PMID: 30973446 PMCID: PMC6629348 DOI: 10.1097/cm9.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Huang J, Li L, Zhang J, Gao C, Quan W, Tian Y, Sun J, Tian Q, Wang D, Dong J, Zhang J, Jiang R. Treatment of Relapsed Chronic Subdural Hematoma in Four Young Children with Atorvastatin and Low-dose Dexamethasone. Pharmacotherapy 2019; 39:783-789. [PMID: 31069819 DOI: 10.1002/phar.2276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic subdural hematoma (CSDH) can develop in children in rare cases. Burr-hole drainage (BHD) is the treatment of choice, but it is associated with a high rate of recurrence. This report describes four cases of pediatric patients (1-7 yrs of age) with post-BHD relapsed CSDH who were successfully treated with a drug regimen that included 2.5-5 mg atorvastatin daily combined with dexamethasone with stepwise-decreasing dosing for a total of 4 weeks. After 4 weeks of treatment, the hematoma was completely resolved in three patients and significantly reduced in one patient. During the treatment, no patient reported clinically significant adverse events. No patient experienced hematoma relapse during the follow-up period that lasted for up to 4 years. This case report suggests the need for a randomized placebo-controlled trial to evaluate this drug regimen for nonsurgical treatment of patients with relapsed CSDH.
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Affiliation(s)
- Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Lihong Li
- Department of Neurosurgery, Tangdu Hospital, Army Military University, Xian, China
| | - Jingyi Zhang
- Department of Neurosurgery, Yangquan 1st People's Hospital, Yangquan, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Qilong Tian
- Department of Neurosurgery, Tangdu Hospital, Army Military University, Xian, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jingfei Dong
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
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Mohammad S, Nguyen H, Nguyen M, Abdel-Rasoul M, Nguyen V, Nguyen C, Nguyen K, Li L, Kitzmiller J. Pleiotropic Effects of Statins: Untapped Potential for Statin Pharmacotherapy. Curr Vasc Pharmacol 2019; 17:239-261. [DOI: 10.2174/1570161116666180723120608] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/15/2022]
Abstract
Background: Statins are effective for primary and secondary prevention of atherosclerotic
cardiovascular disease. They also have systemic anti-inflammatory and immunomodulating properties
suggesting potential utility for improving clinical outcomes for a wide range of diseases. The literature
provides data suggesting benefit in patients with comorbidities associated with contrast-induced nephropathy
(CIN), chronic obstructive pulmonary disease (COPD), pneumonia, head injury, neurological
disease (e.g. Alzheimer’s and Parkinson’s disease), prostate cancer, nuclear cataract and spinal cord
injury. This systematic review evaluates the current evidence supporting the potential benefit of statins
outside their customary role of attenuating cardiovascular risk reduction.
</P><P>
Methods: The electronic databases MEDLINE, EMBASE, and clinicaltrials.gov were searched for studies
published January 2000 - March 2018 reporting comorbidity reduction associated with statin use.
</P><P>
Results: Fifty-eight publications that satisfied our selection criteria (based on the PRISM guidance for
systematic reviews) were selected and included case-control, cohort, cross-sectional and observational
studies as well as systematic reviews and meta-analyses. Ten studies addressed statin use and incidence
of CIN after coronary imaging; 8 addressed statin use in patients with COPD; 14 addressed statin use
and comorbidity reduction associated with head injury and/or a neurological disease disorder; 5 addressed
the association between statin use and nuclear cataract; 9 addressed the association between
statin use and prostate/colorectal cancer; 9 studies addressed the role of statin use in treating infections;
and 3 addressed the association between statin use and spinal cord injury related survival rate.
</P><P>
Conclusion: Overall, the literature supports beneficial pleiotropic effects of statin use in contrastinduced
nephropathy, head injury, Alzheimer’s and Parkinson’s disease, nuclear cataract, prostate cancer,
infection management, and spinal cord injury. Further investigation is warranted, and randomized
clinical trials are needed to confirm the clinical utility suggested by the reported studies included in this
meta-analysis.
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Affiliation(s)
- S. Mohammad
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
| | - H. Nguyen
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
| | - M. Nguyen
- The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH 43210, United States
| | - M. Abdel-Rasoul
- The Ohio State University, College of Medicine, Center for Biostatistics, Columbus, OH 43210, United States
| | - V. Nguyen
- The Nguyen Tri Phuong Hospital, Department of Cardiology, HCM City, Vietnam
| | - C.D. Nguyen
- Department of Otolaryngology, The University of Medicine and Pharmacy at Ho Chi Minh City, HCM City, Vietnam
| | - K.T. Nguyen
- Department of Otolaryngology, The University of Medicine and Pharmacy at Ho Chi Minh City, HCM City, Vietnam
| | - L. Li
- Department of Medical Informatics, The Ohio State University, College of Medicine, Columbus, OH 43210, United States
| | - J.P. Kitzmiller
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
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43
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Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg 2019; 11:912-915. [DOI: 10.1136/neurintsurg-2019-014730] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses in adults. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. We review the potential role for the endovascular management of cSDH within the context of a discussion of the epidemiology, pathophysiology, and conventional management of this disease.
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44
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Tang R, Shi J, Li X, Zou Y, Wang L, Chen Y, Yan R, Gao B, Feng H. Effects of Atorvastatin on Surgical Treatments of Chronic Subdural Hematoma. World Neurosurg 2018; 117:e425-e429. [PMID: 29920396 DOI: 10.1016/j.wneu.2018.06.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effects of atorvastatin on the surgical treatment of patients with chronic subdural hematoma (CSDH). METHODS Our retrospective study included 245 consecutive adult patients undergoing burr-hole craniotomy for CSDH. Data included baseline characteristics and recurrence, postoperative complications, and mortality. Univariate and multivariate regression models analyzed the association between administration of atorvastatin perioperatively and recurrence rates. RESULTS Multivariate analysis showed perioperative atorvastatin administration (odds ratio [OR] 0.336; P = 0.039), diabetes mellitus (OR 3.949, P = 0.010), and GCS of 15 preoperatively (OR 0.197; P = 0.020) to be significantly related to recurrence risk. Postoperative complications and mortality did not significantly differ between patients with and those without atorvastatin therapy. CONCLUSIONS Our findings demonstrate that the administration of atorvastatin perioperatively is associated with a lower risk of CSDH recurrence rate. The use of atorvastatin perioperatively was not associated with higher rates of morbidity or mortality.
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Affiliation(s)
- Rongrui Tang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jiantao Shi
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongjie Zou
- Department of Neurosurgery, No. 184 of PLA Hospital, Yingtan, China
| | - Long Wang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Rubin Yan
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Boyuan Gao
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China.
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45
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Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K, van der Gaag NA, Miah IP, Kho KH, den Hertog HM, Lingsma HF, Dammers R. Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future. World Neurosurg 2018; 116:402-411.e2. [PMID: 29772364 DOI: 10.1016/j.wneu.2018.05.037] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is one of the more frequent pathologic entities in daily neurosurgical practice. Historically, CSDH was considered progressive recurrent bleeding with a traumatic cause. However, recent evidence has suggested a complex intertwined pathway of inflammation, angiogenesis, local coagulopathy, recurrent microbleeds, and exudates. The aim of the present review is to collect existing data on pathophysiology of CSDH to direct further research questions aiming to optimize treatment for the individual patient. METHODS We performed a thorough literature search in PubMed, Ovid, EMBASE, CINAHL, and Google scholar, focusing on any aspect of the pathophysiology and nonsurgical treatment of CSDH. RESULTS After a (minor) traumatic event, the dural border cell layer tears, which leads to the extravasation of cerebrospinal fluid and blood in the subdural space. A cascade of inflammation, impaired coagulation, fibrinolysis, and angiogenesis is set in motion. The most commonly used treatment is surgical drainage. However, because of the pathophysiologic mechanisms, the mortality and high morbidity associated with surgical drainage, drug therapy (dexamethasone, atorvastatin, tranexamic acid, or angiotensin-converting enzyme inhibitors) might be a beneficial alternative in many patients with CSDH. CONCLUSIONS Based on pathophysiologic mechanisms, animal experiments, and small patient studies, medical treatment may play a role in the treatment of CSDH. There is a lack of level I evidence in the nonsurgical treatment of CSDH. Therefore, randomized controlled trials, currently lacking, are needed to assess which treatment is most effective in each individual patient.
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Affiliation(s)
- Dana C Holl
- Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands.
| | - Victor Volovici
- Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Public Health and Medical Decision Making, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Haaglanden MC and Haga Teaching Hospital, The Hague, The Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Haaglanden MC and Haga Teaching Hospital, The Hague, The Netherlands
| | - Ishita P Miah
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Kuan H Kho
- Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Hester F Lingsma
- Department of Public Health and Medical Decision Making, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
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Zhang J, Liu X, Fan X, Fu K, Xu C, Hu Q, Jiang P, Chen J, Wang W. The use of endoscopic-assisted burr-hole craniostomy for septated chronic subdural haematoma: A retrospective cohort comparison study. Brain Res 2018; 1678:245-253. [DOI: 10.1016/j.brainres.2017.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
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Zhang J, Fan X, Liu X, Chen J, Wang W, Fu K. WITHDRAWN: The Optimal Treatment Options of Septated Chronic Subdural Hematoma: A Retrospective Comparison of Craniotomy Versus Endoscopic-Assisted Burr-Hole Craniostomy. World Neurosurg 2017:S1878-8750(17)31932-0. [PMID: 29138075 DOI: 10.1016/j.wneu.2017.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xingyue Fan
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xuemeng Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Fu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Qiu S, Zhuo W, Sun C, Su Z, Yan A, Shen L. Effects of atorvastatin on chronic subdural hematoma: A systematic review. Medicine (Baltimore) 2017; 96:e7290. [PMID: 28658127 PMCID: PMC5500049 DOI: 10.1097/md.0000000000007290] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 06/02/2017] [Accepted: 06/03/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The high recurrent rate of chronic subdural hematoma (CSDH) has consistently confused the neurosurgeons, and the role of atorvastatin in the management of CSDH has remained unclear over past decade, and atorvastatin seems to be a safe and cost-effective treatment to CSDH. Therefore, it is necessary to conduct a systematic review to discuss the effect of atorvastatin in CSDH. METHOD We searched the PubMed, EMBASE, Cochrane Library, and the China Biology Medicine disc, up to March 2017, for published studies on the effects of atorvastatin in the management of CSDH, and reviewers performed a brief qualitative descriptive analysis of atorvastatin's efficacy in the management of CSDH. RESULTS Three eligible studies were included in this systematic review. Results indicated that atorvastatin accelerated hematoma absorption, decreased recurrence risk, and surgical requirement. CONCLUSION Limited evidence suggests that oral atorvastatin may be beneficial in the management of CSDH. Further high-quality studies focused on dosage, duration, hematoma size are needed to further elucidate the role of atorvastatin in the management of CSDH.
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Affiliation(s)
- Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang
| | - Wang Zhuo
- School of Nursing, Soochow University
| | - Chunming Sun
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang
| | - Ai Yan
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang
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Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017; 14:108. [PMID: 28558815 PMCID: PMC5450087 DOI: 10.1186/s12974-017-0881-y] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/15/2017] [Indexed: 02/08/2023] Open
Abstract
Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.
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Affiliation(s)
- Ellie Edlmann
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Susan Giorgi-Coll
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Peter C. Whitfield
- Southwest Neurosurgical Centre, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH UK
| | - Keri L. H. Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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