Objective To explore the clinical value of subcutaneous tunneling in the management of chronic subdural hematoma.Methods A retrospective analysis was conducted on 279 cases of unilateral chronic subdural hematoma treated at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019.The patients were randomly assigned to subcutaneous tunnel group(n=164)and control group(n=115)through double-blind randomization.In the subcutaneous tunnel group,the intraoperative drainage tube was extracted through a subcutaneous tunnel,while in the control group,the drainage tube was removed directly from the incision.We analyzed the hematoma clearance rate,complications,and hematoma recurrence rate after 6 months.Results There was no statistical significance in age,sex,comorbidities,hematoma side or hematoma volume between the two groups(P＞0.05).Subcutaneous tunnel group and control group did not significantly differ in operation time[(27.68±4.1)min vs.(27.50±4.02)min],hospital stay[(7.39±1.04)d vs.(7.42±1.04)d],tube removal time[(24.30±4.82)h vs.25.37±5.02)h],or other clinical features(all P＞0.05).The clearance rate of hematoma was significantly higher in subcutaneous tunnel group than in control group(97.6％vs.95.7％,Z=-3.897,P＜0.001).There were 6 cases(3.7％)of hematoma recurrence in the subcutaneous tunnel group and 11 cases(9.6％)in the control group.The subcutaneous tunnel group had significantly lower recurrence of hematoma than the control group(x2=4.122,P=0.042).Conclusion Subcutaneous tunneling for drainage in the treatment of chronic subdural hematoma can increase the hematoma clearance rate and reduce the rates of complications and recurrence.This technique is simple and worthy of broad clinical application.

Objective To investigate the potential mechanism of atorvastatin in treating chronic subdural hematoma(CSDH)through network pharmacology and experimental validation,thereby providing theoretical foundation and experimental evidence for further basic and clinical research.Methods The target genes of atorvastatin and CSDH-related genes were identified through network databases including chEMBL,NCBI PubChem Compound,SwissTargetPrediction,GeneCards,and DisGeNET.Potential target genes of atorvastatin for CSDH treatment were screened using Venn diagrams,followed by enrichment analysis performed with R software.Protein-protein interaction(PPI)analysis was conducted using the STRING database,and molecular docking was employed to verify the binding capability between atorvastatin and the proteins encoded by the target genes.An endothelial cell inflammation model was established to assess the effects of atorvastatin on the expression and secretion of inflammation-related genes using Real-time quantitative reverse transcription polymerase chain reaction(RT-qPCR)and enzyme-linked immunosorbent assay(ELISA).The impact of atorvastatin on endothelial barrier function in the inflammation model was evaluated using the FITC-Dextran permeability assay.Results A total of 19 potential target genes of atorvastatin for CSDH treatment were identified.Enrichment analysis indicated that these genes are primarily involved in the regulation of inflammation,angiogenesis,and coagulation/fibrinolysis processes.Based on the PPI analysis,five key target genes-matrix metalloproteinase 2(MMP-2),matrix metalloproteinase 9(MMP-9),interleukin-6(IL-6),C-X-C motif chemokine ligand 8/interleukin 8(CXCL-8/IL-8),and serpin family E member 1(SERPINE-1)—were selected for molecular docking,which revealed favorable binding interactions between atorvastatin and these proteins.In the endothelial cell inflammation model,atorvastatin suppressed the expression and secretion of the aforementioned genes as well as inflammatory markers such as intercellular adhesion molecule 1(ICAM-1)and vascular cell adhesion molecule 1(VCAM-1)(IL-6:F=64.526,P＜0.001;CXCL-8/IL-8:F=37.779,P＜0.001;ICAM-1:F=86.253,P＜0.001;VCAM-1:F=39.631,P＜0.001;MMP-2:F=264.413,P＜0.001;MMP-9:F=86.675,P＜0.001;SERPINE-1:F=71.180,P＜0.001).Furthermore,atorvastatin alleviated endothelial barrier dysfunction caused by inflammation(F=343.890,P＜0.001).Conclusion Atorvastatin may exert therapeutic effects on CSDH by inhibiting inflammatory responses.

Objective To investigate the potential mechanism of atorvastatin in treating chronic subdural hematoma(CSDH)through network pharmacology and experimental validation,thereby providing theoretical foundation and experimental evidence for further basic and clinical research.Methods The target genes of atorvastatin and CSDH-related genes were identified through network databases including chEMBL,NCBI PubChem Compound,SwissTargetPrediction,GeneCards,and DisGeNET.Potential target genes of atorvastatin for CSDH treatment were screened using Venn diagrams,followed by enrichment analysis performed with R software.Protein-protein interaction(PPI)analysis was conducted using the STRING database,and molecular docking was employed to verify the binding capability between atorvastatin and the proteins encoded by the target genes.An endothelial cell inflammation model was established to assess the effects of atorvastatin on the expression and secretion of inflammation-related genes using Real-time quantitative reverse transcription polymerase chain reaction(RT-qPCR)and enzyme-linked immunosorbent assay(ELISA).The impact of atorvastatin on endothelial barrier function in the inflammation model was evaluated using the FITC-Dextran permeability assay.Results A total of 19 potential target genes of atorvastatin for CSDH treatment were identified.Enrichment analysis indicated that these genes are primarily involved in the regulation of inflammation,angiogenesis,and coagulation/fibrinolysis processes.Based on the PPI analysis,five key target genes-matrix metalloproteinase 2(MMP-2),matrix metalloproteinase 9(MMP-9),interleukin-6(IL-6),C-X-C motif chemokine ligand 8/interleukin 8(CXCL-8/IL-8),and serpin family E member 1(SERPINE-1)—were selected for molecular docking,which revealed favorable binding interactions between atorvastatin and these proteins.In the endothelial cell inflammation model,atorvastatin suppressed the expression and secretion of the aforementioned genes as well as inflammatory markers such as intercellular adhesion molecule 1(ICAM-1)and vascular cell adhesion molecule 1(VCAM-1)(IL-6:F=64.526,P＜0.001;CXCL-8/IL-8:F=37.779,P＜0.001;ICAM-1:F=86.253,P＜0.001;VCAM-1:F=39.631,P＜0.001;MMP-2:F=264.413,P＜0.001;MMP-9:F=86.675,P＜0.001;SERPINE-1:F=71.180,P＜0.001).Furthermore,atorvastatin alleviated endothelial barrier dysfunction caused by inflammation(F=343.890,P＜0.001).Conclusion Atorvastatin may exert therapeutic effects on CSDH by inhibiting inflammatory responses.

Objective To explore the clinical value of subcutaneous tunneling in the management of chronic subdural hematoma.Methods A retrospective analysis was conducted on 279 cases of unilateral chronic subdural hematoma treated at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019.The patients were randomly assigned to subcutaneous tunnel group(n=164)and control group(n=115)through double-blind randomization.In the subcutaneous tunnel group,the intraoperative drainage tube was extracted through a subcutaneous tunnel,while in the control group,the drainage tube was removed directly from the incision.We analyzed the hematoma clearance rate,complications,and hematoma recurrence rate after 6 months.Results There was no statistical significance in age,sex,comorbidities,hematoma side or hematoma volume between the two groups(P＞0.05).Subcutaneous tunnel group and control group did not significantly differ in operation time[(27.68±4.1)min vs.(27.50±4.02)min],hospital stay[(7.39±1.04)d vs.(7.42±1.04)d],tube removal time[(24.30±4.82)h vs.25.37±5.02)h],or other clinical features(all P＞0.05).The clearance rate of hematoma was significantly higher in subcutaneous tunnel group than in control group(97.6％vs.95.7％,Z=-3.897,P＜0.001).There were 6 cases(3.7％)of hematoma recurrence in the subcutaneous tunnel group and 11 cases(9.6％)in the control group.The subcutaneous tunnel group had significantly lower recurrence of hematoma than the control group(x2=4.122,P=0.042).Conclusion Subcutaneous tunneling for drainage in the treatment of chronic subdural hematoma can increase the hematoma clearance rate and reduce the rates of complications and recurrence.This technique is simple and worthy of broad clinical application.