Top

Acta Neurochirurgica

Published in:

Open Access 01-07-2021 | Subdural Hematoma | Original Article - Neurosurgery general

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Authors: Johann Klein, Lisa Mauck, Gabriele Schackert, Thomas Pinzer

Published in: Acta Neurochirurgica | Issue 7/2021

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.

Chan DYC, Chan DTM, Sun TFD, Ng SCP, Wong GKC, Poon WS (2017) The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study*. Br J Neurosurg 31(1):72–77CrossRef

Gandelman K, Fung GL, Messig M, Laskey R (2012) Systemic exposure to atorvastatin between Asian and Caucasian subjects. Am J Ther. https://doi.org/10.1097/MJT.0b013e3181f28fb5CrossRefPubMed

Grundy SM, Stone NJ, Bailey AL et al (2019) 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. https://doi.org/10.1161/CIR.0000000000000625CrossRefPubMed

Hu M, Lui SSH, Ko GTC, Tomlinson B (2013) Do the lipid responses to rosuvastatin and atorvastatin differ between Chinese and Caucasians? Comparison of the DISCOVERY-Hong Kong study with other DISCOVERY studies. Int J Cardiol 168(3):3071–3073CrossRef

Huang J, Li L, Zhang J et al (2019) Treatment of relapsed chronic subdural hematoma in four young children with atorvastatin and low-dose dexamethasone. Pharmacotherapy 39(7):783–789CrossRef

Huang J, Tian Y, Song Y et al (2019) Effect of different factors on the short-term outcome of Chinese patients with primary chronic subdural hematoma at different age groups: a two-center retrospective study. Front Aging Neurosci. https://doi.org/10.3389/fnagi.2019.00325CrossRefPubMedPubMedCentral

Jiang R, Zhao S, Wang R et al (2018) Safety and efficacy of atorvastatin for chronic subdural hematoma in chinese patients: a randomized clinical trial. JAMA Neurol 75(11):1338–1346CrossRef

Li Y-F, Feng Q-Z, Gao W-Q, Zhang X-J, Huang Y, Chen Y-D (2015) The difference between Asian and Western in the effect of LDL-C lowering therapy on coronary atherosclerotic plaque: a meta-analysis report. BMC Cardiovasc Disord. https://doi.org/10.1186/1471-2261-15-6CrossRefPubMedPubMedCentral

Liu H (2017) Retraction: Effect of atorvastatin on resolution of chronic subdural hematoma: a prospective observational study. J Neurosurg. https://doi.org/10.3171/2016.10.JNS151991rCrossRefPubMed

10.

Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H (1981) The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55(3):390–396CrossRef

11.

Nakamura H, Arakawa K, Itakura H et al (2006) Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet 368(9542):1155–1163CrossRef

12.

Okano A, Oya S, Fujisawa N, Tsuchiya T, Indo M, Nakamura T, Chang HS, Matsui T (2014) Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: optimal management of patients on antiplatelet therapy. Br J Neurosurg 28(2):204–208CrossRef

13.

Palinski W (2001) New evidence for beneficial effects of statins unrelated to lipid lowering. Arterioscler Thromb Vasc Biol 21(1):3–5

14.

Peng D, Zhu Y (2016) External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011402.pub2CrossRefPubMedPubMedCentral

15.

Peto R, Collins R (2018) Trust the blinded randomized evidence that statin therapy rarely causes symptomatic side effects. Circulation 138(15):1499–1501CrossRef

16.

Rauhala M, Helén P, Huhtala H, Heikkilä P, Iverson GL, Niskakangas T, Öhman J, Luoto TM Chronic subdural hematoma-incidence, complications, and financial impact. https://doi.org/10.1007/s00701-020-04398-3/Published

17.

SCANDINAVIANSIMVASTATINSURVIVAL (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. https://doi.org/10.1016/S0140-6736(94)90566-5CrossRef

18.

Soleman J, Kamenova M, Lutz K, Guzman R, Fandino J, Mariani L (2017) Drain insertion in chronic subdural hematoma: an international survey of practice. World Neurosurg. https://doi.org/10.1016/j.wneu.2017.04.134CrossRefPubMed

19.

Soleman J, Nocera F, Mariani L (2017) The conservative and pharmacological management of chronic subdural haematoma. Swiss Med Wkly. https://doi.org/10.4414/smw.2017.14398CrossRefPubMed

20.

Tang R, Shi J, Li X, Zou Y, Wang L, Chen Y, Yan R, Gao B, Feng H (2018) Effects of atorvastatin on surgical treatments of chronic subdural hematoma. World Neurosurg 117:e425–e429CrossRef

21.

Wang D, Li T, Wei H et al (2016) Atorvastatin enhances angiogenesis to reduce subdural hematoma in a rat model. J Neurol Sci. https://doi.org/10.1016/j.jns.2016.01.017CrossRefPubMedPubMedCentral

22.

Wang D, Gao C, Xu X et al (2020) Treatment of chronic subdural hematoma with atorvastatin combined with low-dose dexamethasone: phase II randomized proof-of-concept clinical trial. J Neurosurg. https://doi.org/10.3171/2019.11.JNS192020CrossRefPubMed

23.

Weis M, Heeschen C, Glassford AJ, Cooke JP (2002) Statins have biphasic effects on angiogenesis. Circulation. https://doi.org/10.1161/hc0602.103393CrossRefPubMed

24.

Weng T-C, Yang Y-HK, Lin S-J, Tai S-H (2010) A systematic review and meta-analysis on the therapeutic equivalence of statins. J Clin Pharm Ther. https://doi.org/10.1111/j.1365-2710.2009.01085.xCrossRefPubMed

25.

Xu M, Chen P, Zhu X, Wang C, Shi X, Yu B (2016) Effects of atorvastatin on conservative and surgical treatments of chronic subdural hematoma in patients. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.03.067CrossRefPubMed

26.

Yang J, Li L, Wang K, He Y, Sheng Y, Xu L, Huang X, Guo F, Zheng Q (2011) Race differences: modeling the pharmacodynamics of rosuvastatin in Western and Asian hypercholesterolemia patients. Acta Pharmacol Sin. https://doi.org/10.1038/aps.2010.169CrossRefPubMedPubMedCentral

27.

Zou H, Zhu XX, Ding YH, Zhang GB, Geng Y, Huang DS (2017) Statins in conditions other than hypocholesterolemic effects for chronic subdural hematoma therapy, old drug, new tricks? Oncotarget 8(16):27541–27546

28.

Heart Protection Study Collaborative Group (2002) MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet (London, England) 360(9326):7–22

29.

(2016) Retraction: Atorvastatin may attenuate recurrence of chronic subdural hematoma [Front. Neurosci., 10, 303, (2016)] https://doi.org/10.3389/fnins.2016.00303. Front Neurosci. https://doi.org/10.3389/fnins.2016.00465

Title: Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?
Authors: Johann Klein
Lisa Mauck
Gabriele Schackert
Thomas Pinzer
Publication date: 01-07-2021
Publisher: Springer Vienna
Keywords: Subdural Hematoma
Atorvastatin
Craniotomy
Hematoma
Statins
Simvastatin
Published in: Acta Neurochirurgica / Issue 7/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04871-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2021

Radiotherapy versus combination radiotherapy-bevacizumab for the treatment of recurrent high-grade glioma: a systematic review

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience

Risk factors for need of reoperation in bilateral chronic subdural haematomas

Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience

Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls

Correction to: Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience