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Expert consensus on drug treatment of chronic subdural hematoma
Jianning Zhang1,2,3,4,
1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. jianningzhang@hotmail.com.
Insights
Drug treatment offers a safe alternative for chronic subdural hematoma (CSDH) in elderly patients. Atorvastatin combined with dexamethasone shows promise, with regular CT/MRI scans monitoring progress.
Area of Science:
- Neurosurgery
- Neurology
- Geriatrics
Background:
- Chronic subdural hematoma (CSDH) is a space-occupying lesion post-traumatic brain injury, often affecting the elderly.
- Surgical treatment for CSDH has high recurrence (33%) and mortality (32%) rates, especially in frail elderly patients.
- Elderly patients often have comorbidities, increasing surgical risks and limiting treatment options.
Purpose of the Study:
- To evaluate drug treatment as a safe and effective alternative for CSDH in elderly patients.
- To assess the combined therapeutic effect of atorvastatin and dexamethasone for CSDH.
- To establish guidelines for monitoring drug treatment efficacy in CSDH patients.
Main Methods:
- Low-dose, long-term atorvastatin (20mg/d) for at least 8 weeks.
- Adjunctive low-dose, short-term dexamethasone to enhance atorvastatin's effect.
- Regular CT or MRI scanning within 2 weeks of initiating drug treatment.
Main Results:
- Drug treatment provides a safer alternative for elderly patients with CSDH.
- Combination therapy with atorvastatin and dexamethasone improves CSDH treatment outcomes.
- Continuous monitoring via CT/MRI is crucial for assessing treatment response.
Conclusions:
- Pharmacological intervention with atorvastatin and dexamethasone is a viable treatment for CSDH, particularly in high-risk elderly patients.
- This approach mitigates risks associated with surgery, offering improved prognosis.
- Adherence to recommended treatment duration and post-treatment imaging is essential for successful management.
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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