Chronic subdural hematoma (CSDH) is a common neurological disease that involves the collection of blood products in the subdural space. The progression of CSDH is an angiogenic and inflammatory process, but the multifactorial mechanisms underlying CSDH are still not fully understood. We aimed to identify one or more factors that may play an important role in the development of CSDH. We enrolled 83 patients with CSDH, including 17 postoperative patients, and analyzed 20 markers in the hematoma fluid and peripheral blood of each patient. Overall differential gene expression was examined to identify the representative markers. The concentration of MMP-8 was significantly lower in the postoperative group than in the preoperative group. The concentration of MMP-9 was significantly higher in the postoperative group than in the preoperative group. These findings indicate that MMP-8 and MMP-9 may play important roles in the pathophysiology of CSDH. Understanding the pathways associated with CSDH may provide insights for improving disease outcomes.

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Background Chronic subdural hematoma (CSDH) is a common neurological disorder in older patients, and immediate outcomes of surgery for CSDH are satisfactory. However, the evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in CSDH remains controversial. In this study, we aimed to assess the latest evidence on the use of SPD versus SDD in patients with CSDH who underwent burr hole evacuation. Methods We performed a systematic literature search on the use of SPD compared with that of SDD in patients with CSDH in PubMed, Web of Science, Embase, and Cochrane online databases from inception until December 2021. The inclusion and exclusion criteria were defined for eligible studies. A fixed-effects model was used when homogeneity was observed. Results A total of 1013 participants from six studies were included. There were no significant differences in the recurrence rate (odds ratios [OR], 0.87; 95% confidence interval [CI], 0.61–1.26; I2 = 0%; P = 0.47) or the mortality rate (P = 0.89) between the SPD and SDD groups. Additionally, various characteristics, including the rate of subsequent seizures (P = 0.74), sex distribution (P = 0.37), and favorable clinical outcome rates (OR, 1.13; 95% CI, 0.74–1.72; I2 = 0%; P = 0.58), were also similar between the two groups. Moreover, there was no significant difference in the effects of antithrombotic agents between the two groups (P = 0.12). Conclusions There were no differences in recurrence rates, sex distribution, postoperative mortality, seizures, favorable outcomes (modified Rankin scale score: 0–3), or effects of antithrombotic agents between the SPD and SDD groups. These findings suggest that both SPD and SDD are equally effective in treating patients with CSDH.

Rationale: Hydrocephalus is a common disease in neurosurgery. The typical symptoms of hydrocephalus include urinary incontinence, gait instability, and cognitive decline. Irritability rarely occurs in patients with hydrocephalus. Irritability rarely occurs in patients with hydrocephalus, especially in long-standing overt ventriculomegaly of adulthood (LOVA). Patient concerns: A 30-year-old female was admitted to our hospital because of mental retardation and unstable gait for more than 15 years. She had undergone ventriculoperitoneal shunt 15 years prior due to ventriculomegaly and related symptoms. However, the shunt catheter was removed shortly after surgery because of blockage, with no further postoperative treatment. Diagnosis: The patient was diagnosed with long-standing overt ventriculomegaly according to her head circumference and clinical symptoms, including adult hydrocephalus development, overt triventriculomegaly and absence of a secondary cause for aqueductal stenosis in adulthood. Interventions: After considerable discussion, she underwent ventriculoperitoneal shunt placement and showed dramatic and sustained improvement. Outcomes: The patient has been followed at 3-month intervals for over 2 years since discharge, and both the patient and family have reported a significant change in their daily life. She was able to live independently and control her emotions. Slight epilepsy was noted approximately 5 months after surgery but recovered 2 months later. Lessons: It is difficult to decide whether to treat LOVA when the in patients whose symptoms are not significant. We believe that early diagnosis and positive treatment can help improve outcomes and would recommend ventriculoperitoneal (VP) shunting in patients with LOVA.