Exploring conservative avenues in subacute subdural hematoma: the potential role of atorvastatin and dexamethasone as lifesaving allies.

Background: 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.

Case presentation: 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.

Results: 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.

Conclusions: 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.