| ObjectChronic subdural Hematoma is a common disease in neurosurgery with increasing prevalence worldwide, approximately 1/12500 of hematomas occur in older people over 65 years old. The main cause of CSDH is trauma, such as car accident, high attitude falling accident, violence injury and so on, resulting in tearing of cortical arteries or bridging veins. Subsequently newly formed hematoma can lead to the inflammation and neovascularization due to the production of VEGF. As we know, surgery evacuation is the main treatment due to its high efficacy, but postoperative complication and hematoma recurrence limit its clinical application. Thus, dynamic observation or drug treatment is more appropriate for some patients with slight symptoms, so that can avoid the risk of cranial surgery and improve the quality of life. Recently, some clinical trials have demonstrated that glucocorticoids (GCs) may be beneficial for the recovery of CSDH patients as a conservative option. With the use of GCS, over 1/3 patients finely recovered from hematoma and avoided surgery. But the intrinsic side effects of GCs limited it clinical application, such as femoral head necrosis, immune inhibition and so on. Some studies figured out that statins may facilitate the angiogenesis and regeneration of endothelial progenitor cells (EPCs), inhibit inflammation reaction. Hence, it is a promising therapeutic agent to treat CSDH. In this study, we treated 9 CSDH patients by using atorvastatin and designed a tiny control group containing 5 patients with mild symptoms, so as to observe the efficacy of atorvastatin, hematoma reduction and functional recovery of central nerve system.MethodsFollowing the inclusion criteria,14 Patients were recruited from the Shandong University Qilu Hospital and First People's Hospital of Jining after rigorous clinical evaluation to avoid possible complication during the experimental treatment. Among these 14 patients,9 of them were assigned to treatment group to undergo standardized clinical trial and the rest were assigned to control group to receive the conservative treatment which contained nerve nourishing treatment. Since the beginning of the treatment, all of them underwent modified Rankin-Scale (mRS) classification and Glasgow coma scale classification in the 1-7th,14th,21st,28th,90th and 180th day. And Computerized Tomography (CT) was performed in the 7th day,4th,8th,12th,24th month to calculate the volume of hematoma under the help of software. If emergency condition occurs, such as nerve function deterioration, suddenly enlargement of the hematoma, or midline shift over than 10 mm with the risk of brain herniation, doctors should perform hematoma evacuation surgery immediately. All the data were processed by SPSS software package, a value of P<0.05 was considered to be statistically significant.Result1. The volume of hematomas of two groups when admitting is 34.44 ±12.35M1 and 24.20 ±10.73mL (Two-independent T test, t=1.552, df=12, P=0.147, no statistically significance). After 4 weeks'atorvastatin treatment, the volume of hematoma sharply decreased to 18.22±13.16 mL (Paired T test, t=3.960, df=8, P=0.006, statistically significance),1 patients experienced hematoma enlargement and transferred to surgery immediately. In control group, the volume of hematoma still maintained 26.00 ±16.22 mL without significant change (Paired T test, t=0.686, no statistically significance), the volume of a patient increased and turned to surgery immediately. After 24 weeks'treatment,6 patients in treatment group experienced fundamental hematoma absorption, and inefficient in 3 patients. Only 2 experienced absorption in control group, and the rest were inefficient.2. After 24 weeks'treatment, complete absorption of hematoma was observed in 6 patients with well restored GCS. And the volume of hematoma matches the nerve function well. GCS with 5 scores accounted for 6 patients, only 1 patients with GCS 4. As expected, there is no significant difference in control group,3 patients' GCS were 3, and 1 for 4.3.6 patients were treated successfully with a efficacity of 66.67%(6/9). Only there is only patients experienced complete absorption with a efficacy of 20.00%(1/5), which is much lower than treatment group.Conclusion1. The pharmacological effect fit the pathogenesis of CSDH very well with little side effects, facilitating the absorption of CSDH. The volume of hematoma decreased 47% after the treatment.2. Atorvastatin can facilitate the deduction of CSDH and improve the quality of life.3. Atorvastatin is suitable for the patients with mild symptoms to avoid the surgery and its complications and reduce the financial burden or cost.4. Atorvastatin is promising for treating CSDH, but this study is a preliminary research due to its small patient cohort and unequaled groups design, the efficacy of atorvastatin needs to be demonstrated by much more evidence from large scale clinical trials. |
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