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

Introduction: Chronic subdural hematoma (CSDH) is common and more prevalent in the aged population. Surgical intervention is the treatment of choice, but its outcomes may not be satisfactory because of recurrence and physical infirmity associated with aging. Aberrant angiogenesis and localized inflammation contribute to the formation of CSDH. Atorvastatin is active in promoting angiogenesis and modulating inflammation. We hypothesize that atorvastatin is effective in reducing CSDH and have tested the hypothesis in a preliminary prospective study of small cohort of patients. Methods: Twenty-three patients with CT- or MRI-confirmed CSDH were recruited from three regional medical centers and evaluated using Markwalder's Grading Scale (MGS) and the Glasgow Coma Scale (GCS). These patients received oral atorvastatin 20 mg/day for 1-6 months (3.02 +/- 1.77 months) and were followed for 3 to 36 months (18.62 +/- 13.13) after the therapy. Hematoma volume, neurological functions and daily activities (measured using the Activities of Daily Life-the Barthel Index scale, ADL-BI) were compared before and after treatment with Linear Trend Chi-Square test. Results: Twenty-two of the 23 patients experienced improvements in symptoms, and the reduction in hematoma volume from 48.70 +/- 20.38 ml to 16.64 +/- 14.28 ml (paired-sample t-test, p < 0.01) within the first month of the treatment. Hematoma was completely resolved in 17 patients (77.3%) and shrank by more than 73.99% +/- 11.17% in 5 patients (22.7%) 3 months after the treatment was initiated. One patient experienced an initial relief of symptoms, but his condition deteriorated with an enlarged hematoma during the 4th week of treatment and underwent surgery. At 6 months, 18 patients presented no hematoma by CT or MRI and four patients, whose hematoma was completely resolved at 3 months, were not followed. None of these 22 patients relapsed during the entire follow-up period of 3-36 months. All have improved MGS, GCS, and ADL-BI. No atorvastatin-related side effects were documented. Conclusion: Results of this preliminary prospective study show that the oral administration of atorvastatin is safe and effective in treating CSDH, offering a cost-effective alternative to surgery. A prospective randomized clinical trial is required to validate the effect of atonrastatin. (C) 2013 Elsevier B.V. All rights reserved.