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Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma

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Abstract

The objective of this study is to explore whether craniocervical manual lymphatic drainage (cMLD) can promote hematoma absorption and increase the efficiency of atorvastatin-based conservative treatment in chronic subdural hematoma (CSDH) patients. All CSDH patients treated with atorvastatin-based therapy between October 2020 and February 2022 in our department were retrospectively screened for enrollment. The patients were divided into the control and cMLD groups according to whether cMLD was performed. Head CT or MR images in both groups were obtained before the treatment and 2 weeks and 4 weeks after the treatment. MR images of the deep cervical lymphatic nodes (dCLNs) in 23 patients were obtained in the cMLD group before and approximately 2 weeks after treatment. The volumes of the dCLNs and hematoma were calculated. The primary outcomes are the differences in hematoma volume reduction after 4 weeks of treatment. The secondary outcomes were (1) the differences in hematoma volume reduction between the patients in these two groups in the 2nd week, (2) the dCLN volume change in the cMLD group before and after 2 weeks of treatment, and (3) the percentage of patients who transitioned to surgery because of failure to the conservative treatment. A total of 106 consecutive patients were enrolled in this study for analysis; 54 patients received atorvastatin-based treatment (control group), and 52 were treated with both atorvastatin-based treatment and cMLD (cMLD group). At baseline, the mean hematoma volume was 76.53 ± 42.97 ml in the control group and 88.57 ± 49.01 ml in the cMLD group (p = 0.181). In the 4th week, the absolute number of hematoma reductions (20.79 ± 34.73 ml vs. 37.28 ± 28.24 ml, p = 0.009) and percentage of hematoma reductions (22.58% ± 60.01% vs. 46.43% ± 30.12%, p = 0.012) in the cMLD group were greater than those in the control group. After 2 weeks of treatment, the absolute number of hematoma reductions showed no difference in the two groups, while the percentage of hematoma reduction was higher in the cMLD group (18.18% ± 24.61% vs. 2.08% ± 25.72%, p = 0.001). One patient in cMLD and 8 patients in the control group were transitioned to receive surgical treatment. The dCLN volumes in 23 experimental patients increased significantly after 2 weeks of treatment in the cMLD group (p = 0.032). There were no severe side effects that needed to be reported. Combined with atorvastatin-based therapy, cMLD can promote hematoma absorption and decrease the surgery rate, which provides a new therapeutic strategy for CSDH.

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Data Availability

The supporting data of this study are available on request from the corresponding author.

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Acknowledgements

We acknowledge Professor Jia He and her group in the Department of Health Statistics, Second Military Medical University, for the guidance of statistical analysis.

Funding

The authors are funded by the National Natural Science Foundation of China (via grant no. 82001323 to C Gao, grant no. 82071390 to R Jiang, and grant no. 82171359 to D Wang). They are also supported by the Beijing Tianjin Hebei Basic Research Cooperation Project (via grant no. 19JCZDJC64600(Z) to D Wang), the Tianjin Research Program of Application Foundation and Advanced Technology (via grant no. 19YFZCSY00650 to R Jiang), and the Clinical Study of Tianjin Medical University (2017kylc007 to R.J.).

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Author notes

  1. Chuang Gao, Yingsheng Wei and Xinjie Zhang contributed equally to this work

  2. Jianning Zhang, Junping Wang and Rongcai Jiang contributed equally to the supervision of this work

Authors and Affiliations

  1. Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China

    Chuang Gao, Yingsheng Wei, Xinjie Zhang, Jinhao Huang, Meng Nie, Xuanhui Liu, Jiangyuan Yuan, Dong Wang, Ye Tian, Weiwei Jiang, Shuo An, Jian Sun, Zhuang Sha, Yibing Fan, Jiancheng Feng, Mingqi Liu, Shiying Dong, Di Wu, Jianning Zhang & Rongcai Jiang

  2. Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China

    Chuang Gao, Yingsheng Wei, Xinjie Zhang, Jinhao Huang, Meng Nie, Xuanhui Liu, Jiangyuan Yuan, Dong Wang, Ye Tian, Weiwei Jiang, Shuo An, Jian Sun, Zhuang Sha, Yibing Fan, Jiancheng Feng, Mingqi Liu, Shiying Dong, Di Wu, Jianning Zhang & Rongcai Jiang

  3. Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China

    Junping Wang

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Contributions

RJ, JW, JZ, and CG conceived and designed the study and provided funding. YW, CG, and JZ developed the methodology. JH, MN, XL, JY, DW, WJ, YT, SA, ZS, YF, JF, ML, SD, and DW collected the data and calculated the hematoma volume. CG and JW wrote the manuscript. JS and DW provided technical support. RJ and JZ reviewed and revised the manuscript and supervised the study. All authors have read and approved the manuscript.

Corresponding authors

Correspondence to Jianning Zhang, Junping Wang or Rongcai Jiang.

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The authors declare no competing interests.

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This study was approved by the Ethical Committees of General Hospital of Tianjin Medical University in China. Informed consent was obtained from the participants or their legal representatives.

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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Supplementary file3 (MP4 80506 kb) Video legend: The video shows the protocol of cMLD.

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Gao, C., Wei, Y., Zhang, X. et al. Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma. Transl. Stroke Res. 14, 667–677 (2023). https://doi.org/10.1007/s12975-022-01062-z

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