WSC 2025 | The treatment of chronic subdural hematoma: a trial of atorvastatin

So chronic subdural hematoma remains a major cause of brain injury in the community, in the population. As our demography is shifting towards an older population where we’re using more antithrombotics and anticoagulants. If people have a fall, then they’re more likely to get a subdural hematoma. And the mainstay of that treatment is surgery to relieve the pressure. That’s the major damage. But there’s always a bit of uncertainty about operating on those that are mild and stable, allowing the blood to resolve and disappear themselves because any operation, let alone a craniotomy, carries a certain risk. And the other thing we recognise is that just having blood there is inflammatory. And also, if there’s some damage to the tissues related to the consequence of the subdural hematoma, there’s a very high likelihood of recurrence, even with surgery. So atorvastatin is very interesting. All of the statins have similar properties. Atorvastatin is the most commonly used statin for cardiovascular disease. Now, it’s got effects that extend beyond lipid changes, anti-inflammatory effects, and that’s been shown in cardiovascular disease. And so it looks very appealing to reduce the inflammation around the tissues after a subdural hematoma. And that sort of works in a medical way to enhance healing. And that then could improve the outcome from subdural hematoma, either as an adjuvant to surgery or in the mild cases. I’ve been fortunate to have been associated with research groups in neurosurgery within China to do the randomized controlled trials. The quality of the data is good. The background care for subdural hematoma in China is as good as anywhere. It’s a little unusual and there’s always scepticism in the West about research from China and its relevance outside of China. It’s a little different to routine practice, which is predominantly focused on surgery for subdural hematoma. So coming in with a view around medical treatment takes a while to accept as being useful. So the evidence from randomized controlled trials of atorvastatin for mild subdural hematoma in China looks very good. But because it’s different, I think its uptake outside of China is going to be a bit slow until there’s enough appetite and energy and funding support to do a trial directly in that population, in a predominantly Western population.

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