Yuan Jiangyuan, Quan Wei, Liu Xuanhui, Li Pan, Huang Jinhao, Gao Chuang, Liu Tao, Zhang Yongqiang, Zhang Jianning, Jiang Rongcai
State Key Laboratory of Experimental Hematology, Laboratory of Post-Neuroinjury Neurorepair and Regeneration in Central Nervous System Tianjin and Ministry of Education, Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
Front Neurol. 2025 Jun 27;16:1609514. doi: 10.3389/fneur.2025.1609514. eCollection 2025.
Chronic subdural hematoma (CSDH) is a common neurological disorder in the elderly, typically managed through surgical intervention; however, in patients aged 90 years and older, surgery is often not feasible due to comorbidities, anticoagulant use, and other age-related factors. This study evaluates the effects of atorvastatin, either as monotherapy or in combination with dexamethasone, in the conservative treatment of CSDH in patients over 90 years old, while also reviewing the current literature on the management of CSDH in this super-aged population.
Seventeen super-aged patients diagnosed with CSDH at our neurosurgical department between January 2017 and June 2024, who either refused or were considered unsuitable for surgery, were included in the study. Six patients received atorvastatin monotherapy, while 11 were treated with a combination of atorvastatin and dexamethasone. Head imaging scans were analyzed, and the modified Rankin Scale (mRS) and Markwalder's Grading Scale/Glasgow Coma Scale (MGS-GCS) scores were assessed before and after treatment.
At the six-month follow-up, all patients showed significant improvement in neurological symptoms, as reflected by lower mRS and MGS-GCS scores. Hematomas were completely absorbed in 10 patients, significantly reduced in five, and unchanged in two patients with calcified hematoma. Three patients developed hyperglycemia, and one patient exhibited transaminitis; these adverse effects were resolved following the discontinuation of dexamethasone and the use of hepatoprotective medications. No mortality was recorded during the six-month follow-up.
Our findings suggest that atorvastatin-based treatment may improve the prognosis of CSDH in super-aged patients and offer a viable therapeutic alternative for those ineligible for surgery.
慢性硬膜下血肿（CSDH）是老年人常见的神经系统疾病，通常通过手术干预进行治疗；然而，对于90岁及以上的患者，由于合并症、抗凝药物使用及其他与年龄相关的因素，手术往往不可行。本研究评估阿托伐他汀单药治疗或与地塞米松联合治疗对90岁以上CSDH患者保守治疗的效果，同时回顾当前关于这一超高龄人群CSDH治疗的文献。
纳入2017年1月至2024年6月期间在我院神经外科诊断为CSDH且拒绝手术或被认为不适合手术的17例超高龄患者。6例患者接受阿托伐他汀单药治疗，11例患者接受阿托伐他汀与地塞米松联合治疗。分析头部影像学扫描结果，并在治疗前后评估改良Rankin量表（mRS）和Markwalder分级量表/格拉斯哥昏迷量表（MGS-GCS）评分。
在六个月的随访中，所有患者的神经症状均有显著改善，mRS和MGS-GCS评分降低。10例患者血肿完全吸收，5例患者血肿显著缩小，2例钙化血肿患者血肿无变化。3例患者出现高血糖，1例患者出现转氨酶升高；停用 地塞米松并使用保肝药物后，这些不良反应得到缓解。六个月随访期间无死亡病例。
我们的研究结果表明，基于阿托伐他汀的治疗可能改善超高龄CSDH患者的预后，并为那些不适合手术的患者提供一种可行的治疗选择。
