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

Area of Science:

• Neurosurgery
• Pharmacology

Background:

• Chronic subdural hematoma (CSDH) is a common neurosurgical condition with significant recurrence rates (8-33%) and associated morbidity/mortality.
• Pathogenesis is linked to inflammation and aberrant neovascularization within the subdural space.
• Atorvastatin, a lipid-lowering drug, has shown potential in preclinical and preliminary clinical studies to inhibit inflammation and promote vascular maturation.

Purpose of the Study:

• To investigate the efficacy of Atorvastatin in managing patients with chronic subdural hematoma (CSDH).
• To evaluate the impact of Atorvastatin on hematoma resolution and the need for surgical intervention in CSDH patients.

Main Methods:

• A retrospective cohort study comparing 12 CSDH patients treated with Atorvastatin to matched controls who did not receive statin therapy.
• Patients in both groups had Glasgow Coma Scale (GCS) scores of 13-15 and Markwalder's Grading Scale (MGS) Grade 0-2.
• Outcomes assessed included hematoma resolution at 3 months and the rate of deterioration requiring burr-hole drainage.

Main Results:

• Hematoma resolution at 3 months was higher in the Atorvastatin group (75%) compared to the control group (42%), though not statistically significant (p=0.0977).
• The risk of deterioration requiring burr-hole drainage was significantly lower in the Atorvastatin group (16.7%) versus the control group (58.3%) (p=0.0447).
• The Odds Ratio (OR) for deterioration with Atorvastatin was 0.143 (p=0.0451), with a Number Needed to Treat (NNT) of 2.4.

Conclusions:

• This retrospective study suggests Atorvastatin may be beneficial in reducing the rate of deterioration and the need for burr-hole drainage in CSDH patients.
• Atorvastatin's potential anti-inflammatory and vascular-stabilizing effects warrant further investigation in larger, prospective trials for CSDH management.