Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

Stanišić, Milo; Aasen, Ansgar O.; Pripp, Are Hugo; Lindegaard, Karl-Fredrik; Ramm‐Pettersen, Jon; Lyngstadaas, Ståle Petter; Ivanović, Jugoslav; Konglund, Ane; Ilstad, Eivind; Sandell, Tiril; Ellingsen, Omar; Sæhle, Terje

doi:10.1007/s00011-012-0476-0

Cited by 101 publications

(69 citation statements)

References 60 publications

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“…7 The underlying pathogenesis was postulated to be pathological aberrant vessel formation 8 and localised inflammation. 9,10,11 This formed the pathophysiological basis of the use of steroid for CSDH 12,13 and its potential role as a primary non-surgical treatment of CSDH in selected groups of patients. 14 The formation of these immature vessels at the neomembrane was hypothesised to contribute to plasma extravasation and haematoma progression.…”

Section: Introductionmentioning

confidence: 99%

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chan

Sun

et al. 2016

British Journal of Neurosurgery

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Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS-and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p ¼ 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p ¼ 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p ¼ 0.0451). The Number needed to treat (NNT) was 2.4 (p ¼ 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Chan

Sun

et al. 2016

British Journal of Neurosurgery

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“…CSH is currently considered to be a circumscribed chronic self-perpetuating inflammatory disorder that involves the dura mater (23). When CSF or extravasated blood gathers into the restricted area of the dural border cell layer (10,14,17), it evokes a local aseptic inflammatory (9,26) and inflammation-induced angiogenic reactions (11,12,22,25).…”

Section: Discussionmentioning

confidence: 99%

“…When CSF or extravasated blood gathers into the restricted area of the dural border cell layer (10,14,17), it evokes a local aseptic inflammatory (9,26) and inflammation-induced angiogenic reactions (11,12,22,25). The result is that glucocorticoids may specifically impede the formation of neomembranes and neo-capillaries by their powerful inhibition of inflammatory mediators (23). More basic research is needed to clarify the true role of the corticosteroids in the treatment of chronic subdural hematoma.…”

Section: Discussionmentioning

confidence: 99%

Local application of corticosteroids combined with surgery for the treatment of chronic subdural hematoma

Liu²,

Liu³

et al. 2013

Turkish Neurosurgery

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AIm: Combination treatment consisting of surgery and pre-or post-operative corticosteroids for chronic subdural hematoma (CSH) tend to have better outcomes than surgery only. However, there are many complications after long-term use of corticosteroids. In this study, we evaluated the clinical outcomes of local application of corticosteroids combined with surgery for CSH. mATERIAl and mEThods:We retrospectively analysed the data of the patients undergoing surgery and local application of Methylprednisolone Sodium Succinate for Injection (MPSS) into the hematoma cavity. Neurological status was assessed by Markwalder's Grading Scale (MGS). Recurrence was defined as deteriorating neurological status with radiological evidence of reaccumulation. REsulTs:A total of 26 patients were enrolled in this study. During the follow-up period, all patients made excellent neurological recovery. 24 (92.3%) patients' MGS was grade 0 at 12 months after the surgery. There was no mortality or recurrence. 5 patients (19.2%) suffered postoperative complications, of which 2 developed some subdural air collection, 2 had a partial seizure attack and 1 developed an acute epidural hemorrhage. CoNClusIoN:The results suggest that local application of MPSS combined with surgery is a safe and effective method in the management of CSH. It may reduce hematoma recurrence.

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“…Impaired angiogenesis may induce blood leakage from immature vessels of the neomembrane. Repair of vessel leakage is further impeded by localized inflammation [5–8]. …”

Section: Introductionmentioning

confidence: 99%

Statins in conditions other than hypocholesterolemic effects for chronic subdural hematoma therapy, old drug, new tricks?

et al. 2017

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Chronic subdural hematoma (CSDH) is one of the most common intracranial hematomas worldwide with a high incidence in the general population. However, the optimum treatment for CSDH is Burr-hole drainage with or without rinse Considering the poor outcomes of CSDH in aged patients, and ambiguous prediction of recurrence in many sides of recurrent CSDHs who have been analyzed, new effective therapies are needed for those CSDHs who are predicated to have poor prognosis for surgery and/or have a higher risk of recurrence. Statins, which is the first-line treatment for patients with high cholesterol and coronary heart disease. However, statins are still not solely limited in the treatment of these diseases. It has been demonstrated that statins could improve CSDH due to its effect of regulation of angiogenesis and inflammation. In this review, in order to provide potential new treatment for CSDH we summarize the recent findings of statins in CSDH in order to try to clarify the mechanisms of this effect.

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Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

Cited by 101 publications

References 60 publications

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Local application of corticosteroids combined with surgery for the treatment of chronic subdural hematoma

Statins in conditions other than hypocholesterolemic effects for chronic subdural hematoma therapy, old drug, new tricks?

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