Correlation of vascular endothelial growth factor with magnetic resonance imaging in chronic subdural hematomas

Li, Fubin; Cong, Hua; Feng, Yan; Yuan, Hongyan; Bie, Li

doi:10.1016/j.jns.2017.04.013

Cited by 14 publications

(7 citation statements)

References 36 publications

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“…Our study also suggests that VEGFA could serve as a biomarker for evaluating CSDH development, progression and response to treatment [48]. This finding is consistent with extensive previous reports that a high level of VEGFA in haematoma fluid and that outer membrane promotes CSDH growth [24] and associated with a higher rate of recurrence [25].…”

Section: Discussionsupporting

confidence: 92%

Dexamethasone enhances the efficacy of atorvastatin in inhibiting excessively inflammation-induced abnormal angiogenesis by regulating macrophages

Gong

Zhan

Nie

et al. 2021

J Neuroinflammation

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Background We have recently showed that atorvastatin (ATO) combined with low dose of dexamethasone (DEX) was more efficacious in treating patients with chronic subdural haematoma (CSDH) than ATO monotherapy. This study was designed to investigate the underlying mechanisms of the improved efficacy of this combined therapy. Methods Mass spectrometry was performed to quantitatively detect drugs in haematoma fluids and serum samples from CSDH patients and also in cultured macrophages after treatment with either ATO alone or in combination with DEX. The differentiation and apoptosis of macrophages were evaluated using flow cytometry. The expression of cytokines, chemokines and angiogenesis-related proteins was evaluated using proteome profile arrays, immunoblots and ELISA, respectively. Results ATO was detected in haematoma fluids and serum samples, whose levels were increased significantly in samples collected from patients treated with both ATO and DEX. ATO was also increased in cultured macrophages treated with ATO and DEX. The numbers of M1-polarized macrophages were higher than the M2 phenotype in the haematoma fluids of patients. Cultured macrophages treated with ATO and DEX had reduced numbers of M1-polarized macrophages, increased numbers of M2-polarized macrophages as compared to monotherapies, and decreased rate of apoptosis induced by high-dose DEX. DEX enhanced the anti-inflammatory and anti-angiogenic activity of ATO by suppressing VEGFA and other inflammatory angiogenic factors. Consistent with the finding, patients responded well to the drug treatments had lower serum levels of VEGFA. Conclusions We have shown for the first time that ATO given orally was detected in CSDH haematoma fluids. DEX enhances the anti-inflammatory and anti-angiogenic effects of ATO, primarily by increasing the presence of ATO in haematoma and macrophages and by regulating the functions of macrophages.

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Section: Discussionsupporting

confidence: 92%

Dexamethasone enhances the efficacy of atorvastatin in inhibiting excessively inflammation-induced abnormal angiogenesis by regulating macrophages

Gong

Zhan

Nie

et al. 2021

J Neuroinflammation

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“…Their effect is more obvious in the blockage of neomembranes formation by inhibiting inflammatory mediators like lymphokins and prostaglandins in parallel with the stimulation of lipocortin, which is a powerful inhibitor of inflammation and oxidative stress [5,8,12,22]. Glucocorticoids are also stimulating the secretion of the inhibitor of plasminogen which reduces the lysis-rebleeding cycle of the clot [4,13].…”

Section: Table IV the Comparison Between The Groups Regarding The Need Of Surgical Interventionmentioning

confidence: 99%

The Usefulness of Dexamethasone in the Treatment of Chronic Subdural Hematomas

Papacocea¹

2019

FARMACIA

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The purpose of this study was to assess whether the use of dexamethasone in patients with chronic subdural hematomas (CSDH) could lead to avoidance of surgical treatment. Data in the literature showed benefits of dexamethasone in selected patients, sometimes grouped in large cohorts, but studies comparing groups of patients who received or not this medication, from the point of view of surgical therapy prevention, are missing. We analysed 38 patients with the diagnostic of chronic subdural hematoma, separated in 2 groups on the basis of presence or absence of dexamethasone therapy. We found that 59.1% of patients who received dexamethasone didn't need surgical intervention, while only 18.7% of patients who were not treated with dexamethasone escaped surgery. In conclusion, the conservative treatment with dexamethasone can be a safe and efficient therapeutic option for CSDH, which can be used with few risks even in elderly patients with important comorbidities, when the surgical option would be hazardous. With few exceptions, CSDH should not be considered a neurosurgical emergency, treatment with dexamethasone being usually attempted without significant risk for 48 -72 hours. Conservative therapy eliminates the complications related to surgery, some of which are severe. Essentially, dexamethasone therapy involves shorter hospitalization, lower costs, rare severe complications and the possibility for outpatient treatment and follow up. Dexamethasone medication should not be considered a substitute for surgery but an alternative in the majority of cases. RezumatScopul acestui studiu a fost de a evalua dacă utilizarea dexametazonei la pacienții cu hematoame subdurale cronice (HSDC) ar putea duce la evitarea tratamentului chirurgical. Datele din literatura de specialitate au arătat beneficii ale dexametazonei la pacienți selectați, uneori grupați în cohorte mari, dar nu au fost realizate studii care să compare grupuri de pacienți care au primit și, respectiv, nu au primit acest medicament din punctul de vedere al posibilității evitării terapiei chirurgicale. Au fost analizați 38 de pacienți cu diagnosticul de hematom subdural cronic în decursul a doi ani, separați în 2 grupe pe baza prezenței sau absenței terapiei cu dexametazonă . Am descoperit că 59,1% dintre pacienții cărora li s-a administrat dexametazonă nu au avut nevoie de intervenție chirurgicală, în timp ce doar 18,7% dintre pacienții care nu au fost tratați cu dexametazonă au scăpat de operație. În concluzie, tratamentul conservator cu dexametazonă poate fi o opțiune terapeutică sigură și eficientă pentru HSDC, care poate fi utilizată cu un risc redus chiar și la pacienții foarte vârstnici cu co-morbidități importante, la care opțiunea chirurgicală ar fi periculoasă. Cu mici excepții, HSDC nu ar trebui să fie considerat o urgență neurochirurgicală, tratamentul cu dexametazonă putând fi, de obicei, încercat fără riscuri semnificative timp de 48 -72 ore. Terapia conservatoare elimină complicațiile, unele dintre ele severe, legate de intervențiile chirurgicale....

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“… 2 A correlation exists between vascular-endothelial growth factor (VEGF) concentration within this fluid and exudation rate from membrane vessels. 3 VEGF causes angiogenesis that undergoes recurrent micro-bleeding, resulting in increasing hematoma size. Compared to systemic levels, higher ratios of inflammatory to anti-inflammatory mediators exist within the hematoma, 4 promoting angiogenesis, inflammation, hyper-permeability, and progression.…”

Section: Introductionmentioning

confidence: 99%

“… 9 High levels of inflammatory mediators and angiogenic factors within the fluid collection are associated with recurrence. 3 , 4 Corticosteroids may help by promoting anti-inflammatory pathways and vessel maturation, leading to hematoma resolution and reduced recurrence. 10 Dexamethasone is an inflammatory inhibitor showing suppressive effects on VEGF production in rat models.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

Tariq

Bhatti

2021

Pak J Med Sci

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Objectives: To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH). Methods: The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded. Results: Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant. Conclusions: Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant. doi: https://doi.org/10.12669/pjms.37.7.3374 How to cite this:Tariq J, Bhatti SN. Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3374 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Correlation of vascular endothelial growth factor with magnetic resonance imaging in chronic subdural hematomas

Cited by 14 publications

References 36 publications

Dexamethasone enhances the efficacy of atorvastatin in inhibiting excessively inflammation-induced abnormal angiogenesis by regulating macrophages

Dexamethasone enhances the efficacy of atorvastatin in inhibiting excessively inflammation-induced abnormal angiogenesis by regulating macrophages

The Usefulness of Dexamethasone in the Treatment of Chronic Subdural Hematomas

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

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