Liu Tao, Wu Chenrui, Jiang Weiwei, Liu Mingqi, Sha Zhuang, Jiang Rongcai
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Chin Neurosurg J. 2025 Apr 2;11(1):7. doi: 10.1186/s41016-025-00393-8.
Most cases of acute subdural hematoma (ASDH) require emergency surgery; only a few patients can survive without surgery in the early stages and then develop into subacute subdural hematoma (sASDH). However, the optimal conservative treatment has not yet been established for these sASDH patients. Based on our previous studies, atorvastatin plus dexamethasone may be safe and effective for them. This article aims to document such cases and analyze the possible mechanisms.
We selected five patients with sASDH who received a treatment regimen of atorvastatin plus low-dose dexamethasone without surgery. We then observed the clinical and radiological features during treatment and follow-up. The PubMed database and Google Scholar were retrieved for literature regarding the efficacy and safety of conservative treatment in patients with ASDH/sASDH. We extracted information including authors, sample size, gender, number of patients (death, poor prognosis, delayed surgery), and risk factors.
Of the five patients, all patients who refused surgery for various reasons were resolved after treatment with atorvastatin plus low-dose dexamethasone for their conditions. No hematomas recurred or progressed during an at least 6-month follow-up. We identified 6 studies after searching the database; a total of 1374 patients (F:M = 3:7) with ASDH/sASDH received initial conservative treatment. The pooled results showed that 13.1% of patients who initially received conservative treatment deteriorated and required delayed surgical treatment. Of 1374, the overall incidence of poor prognosis was 19.2%, and 7% of patients eventually died.
It is essential to establish an optimal conservative treatment for patients with sASDH who cannot undergo surgery in an emergency for various reasons. Atorvastatin plus dexamethasone may be an alternative treatment in such a subgroup of sASDH, although a randomized proof-of-concept clinical trial is needed.
大多数急性硬膜下血肿（ASDH）病例需要紧急手术；只有少数患者在早期可以不经手术存活，随后发展为亚急性硬膜下血肿（sASDH）。然而，对于这些sASDH患者，尚未确立最佳的保守治疗方法。基于我们之前的研究，阿托伐他汀加地塞米松对他们可能是安全有效的。本文旨在记录此类病例并分析可能的机制。
我们选择了5例接受阿托伐他汀加小剂量地塞米松治疗方案且未进行手术的sASDH患者。然后我们在治疗和随访期间观察了临床和影像学特征。检索了PubMed数据库和谷歌学术，以获取关于ASDH/sASDH患者保守治疗疗效和安全性的文献。我们提取了包括作者、样本量、性别、患者数量（死亡、预后不良、延迟手术）和危险因素等信息。
5例患者中，所有因各种原因拒绝手术的患者在接受阿托伐他汀加小剂量地塞米松治疗后病情均得到缓解。在至少6个月的随访期间，血肿未复发或进展。在搜索数据库后，我们确定了6项研究；共有1374例ASDH/sASDH患者（女性：男性 = 3:7）接受了初始保守治疗。汇总结果显示，最初接受保守治疗的患者中有13.1%病情恶化，需要延迟手术治疗。在1374例患者中，总体预后不良发生率为19.2%，7%的患者最终死亡。
对于因各种原因无法在紧急情况下进行手术的sASDH患者，确立最佳保守治疗方法至关重要。阿托伐他汀加地塞米松可能是此类sASDH亚组的一种替代治疗方法，尽管需要进行一项随机概念验证临床试验。
