• MonteiroGabriel de AlmeidaGADepartment of Neurosurgery, Federal University of Ceara, Sobral, Brazil. Electronic address: gabrielmont00@gmail.com., QueirozThomas Silva deTSDepartment of Neurosurgery, Federal University of Ceara, Sobral, Brazil., Ocílio Ribeiro Gonçalves, Joaquim Francisco Cavalcante-Neto, Sávio Batista, Nicollas Nunes Rabelo, Leonardo Christiaan Welling, Eberval Gadelha Figueiredo, LealPaulo Roberto LacerdaPRLDepartment of Neurosurgery, Federal University of Ceara, Sobral, Brazil., and SollaDavi Jorge FontouraDJFDivision of Neurosurgery, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, São Paulo, Brazil..
• Department of Neurosurgery, Federal University of Ceara, Sobral, Brazil. Electronic address: gabrielmont00@gmail.com.
• World Neurosurg. 2024 Aug 1; 188: 177184177-184.

BackgroundChronic subdural hematoma (CSDH) is a common neurological condition, especially in the elderly population. Atorvastatin has shown the potential to reduce the recurrence of CSDH and improve overall outcomes. New studies have emerged since the last meta-analysis, increasing the sample size and the variety of outcomes analyzed.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies comparing the use of atorvastatin in CSDH patients with a control group or placebo. The primary outcome was the recurrence of CSDH. Secondary outcomes of interest were hematoma volume, composite adverse effects, mortality, and neurological function, measured by the Glasgow Outcome Scale and Barthel index for activities of daily living.ResultsSeven studies, of which 2 were randomized controlled trials, were included, containing 1192 patients. Overall recurrence significantly decreased compared to the control group (risk ratio [RR] 0.46; 95% confidence interval [CI] 0.25-0.83; P=0.009). The benefits of atorvastatin were sustained in the subgroup analysis of patients who underwent initial conservative therapy (RR 0.40; 95% CI 0.22-0.70; P=0.001). However, there was no significant difference when atorvastatin was combined with surgical intervention (RR 0.53; 95% CI 0.21-1.32; P=0.17). Adverse effects were not increased by atorvastatin (RR 0.82; 95% CI 0.51-1.34; P=0.44).ConclusionsAtorvastatin might be beneficial in reducing CSDH recurrence, especially in conservative treatment patients. Atorvastatin was not significantly associated with adverse effects. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy, safety, and optimal dose of atorvastatin in CSDH patients.Copyright © 2024 Elsevier Inc. All rights reserved.

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