Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future

Holl, Dana C; Volovici, Victor; Dirven, Clemens M.F.; Peul, Wilco C.; Kooten, Fop van; Jellema, Korné; Gaag, Niels A. van der; Miah, Ishita P.; Kho, Kuan H.; Hertog, Heleen M. den; Lingsma, Hester F.; Dammers, Rúben

doi:10.1016/j.wneu.2018.05.037

Cited by 149 publications

(139 citation statements)

References 89 publications

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“…In the present study, patients presenting with recurrence of CSDH after previous surgery were excluded. We also excluded asymptomatic patients since the current literature does not provide sufficient data to justify an additional intervention in this population, especially as some asymptomatic CSDHs spontaneously resorb or resorb with conservative treatments 25. Some trials of MMA embolization as an alternative to surgery for symptomatic patients have been reported,14 15 26 but a detailed description of their symptomatic status is necessary to carefully assess the efficacy of MMA embolization in this specific cohort.…”

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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BackgroundChronic subdural hematoma (CSDH) is a common condition requiring surgical treatment; however, recurrence occurs in 15% of cases at 1 year. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.ObjectiveTo investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.MethodsFrom April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST+MMAE group). The primary outcome was HVR measured on the 3 month CT scan compared with the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.Results46 patients were randomized and 41 of these achieved a 3 month follow-up . Twenty-one patients received MMA embolization. At 3 months, the HVR from postsurgical level was higher in the ST+MMAE group (mean difference 17.5 mL, 95% CI 3.87 to 31.16 mL; p=0.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group). No MMA embolization-related adverse events were reported.ConclusionThe addition of MMA embolization to surgery led to an increase in CSDH resorption at 3 months. One recurrence of CSDH was reported in each group, and there were no treatment-related complications.

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Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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“…17,20) This is one of the most convincing hypotheses regarding the pathogenesis of CSDH. 21,22) Furthermore, the inner membrane consists of collagen and fibroblasts only and is considered nonfunctional in the development of CSDH. 20) On the other hand, the outer membrane, which contains layers of fibroblasts and collagen fibers with inflammatory cells such as neutrophils, lymphocytes, macrophages, and eosinophils 17) is considered important for driving CSDH growth.…”

Section: Pathophysiology Of Csdhmentioning

confidence: 99%

Endoscopically Observed Outer Membrane Color of Chronic Subdural Hematoma and Histopathological Staging: White as a Risk Factor for Recurrence

Katsuki

Kakizawa

Wada

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Endoscopic treatment for chronic subdural hematoma (CSDH) has been reported, but endoscopic findings of CSDH have not been thoroughly investigated. This study aimed to elucidate the relationship between endoscopic findings and CSDH recurrence. Furthermore, it examined the association between Nagahori's histopathological staging of CSDH and outer membrane color. Here, we retrospectively analyzed the operative videos of 70 patients with CSDH. The endoscopic findings were investigated, and their correlations with CSDH recurrence, the reduction ratio of the midline shift, and hematoma thickness on day 30 after the operation were analyzed. The outer membrane was white in 21 cases, yellow in 25 cases, and red in 24 cases. CSDH recurred in three (4.2%) patients, all of whom had a white outer membrane (adjusted odds ratio, 18; 95% confidence interval, 1.6-20.6; P = 0.007). The other endoscopic findings were not significantly related to CSDH recurrence, extent of the reduction ratio of the midline shift, or hematoma thickness. The outer membrane colors of white, red, yellow, and white almost corresponded to the histopathological staging from type I to IV in order. Our findings suggest that a white outer membrane is a risk factor for recurrence; these colors may represent the extent of inflammation related to the evolution of CSDH estimated from the histopathological findings.

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“…In patients with CSDH, high VEGF concentration in the hematoma fluid is of major pathophysiological importance in the generation and steady increase of the hematoma volume, which is essential for the formation and remodeling of new vessels [4]. VEGF and the proangiogenic factor angiopoietin 2 create an unstable Evidence-Based Complementary and Alternative Medicine condition with the continuous formation of new and immature capillaries causing extravasation and recurrent microbleeds [16]. Ang-1 can stabilize newly formed blood vessels after pathological insults in mice and stabilize the cortical actin cytoskeleton and promote cell junction integrity and decrease expression of Ang-2 and inflammatory genes in cultured endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, several nonsurgical treatments, such as dexamethasone, cholesterol-lowering drug, and angiotensin-converting enzyme inhibitors which target the inflammation and angiogenesis, are used to treat CSDH [16]. Cholesterol-lowering drug atorvastatin can decrease the TNF-α and IL-6 level as well as VEGF gene expression in rat model [25], and clinical trial also showed atorvastatin may be a safe and efficacious nonsurgical alternative for treating patients with CSDH [26].…”

Section: Discussionmentioning

confidence: 99%

Xiaoyukang Jiaonang Promotes the Degradation of Hypoxia‐Inducible Factor 1α and Antiangiogenesis and Anti‐Inflammation in Chronic Subdural Hematoma Rat Model

Liu

Dong

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Xiaoyukang Jiaonang (XYK) is a Chinese patent medicine approved by the National Medical Product Administration which is used to treat intracranial hematoma in China. In this study, we observed the molecular mechanism of XYK in hypoxia-inducible factor 1α (HIF-1α), inflammation and angiogenesis of chronic subdural hematoma (CSDH). The CSDH model was made by using internal iliac vein blood of Wister rats, and rats were divided into sham group, CSDH group and XYK group. The rats in the XYK group were gavaged with Xiaoyukang Jiaonang (185 mg/kg) for 7 days, and rats in the CSDH group and sham group were gavaged with the same amount of physiological saline for 7 days. In the CSHD rat model, active inflammation and angiogenesis were observed around the hematoma. XYK promoted the ubiquitination and degradation of HIF-1α, and reduced the concentration of VEGF and the ratio of angiopoietin-1/angiopoietin-2. XYK reduced proinflammatory cytokines and increased anti-inflammatory cytokine. In tissue section, XYK reduced the size of the hematoma and membrane, and reduced vWF positive cells in membrane. Furthermore, the endothelial progenitor cells in blood decreased as well. Overall, XYK shows anti-inflammatory and antiangiogenesis effects which may relate to the degradation of HIF-1α.

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Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future

Cited by 149 publications

References 89 publications

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Endoscopically Observed Outer Membrane Color of Chronic Subdural Hematoma and Histopathological Staging: White as a Risk Factor for Recurrence

Xiaoyukang Jiaonang Promotes the Degradation of Hypoxia‐Inducible Factor 1α and Antiangiogenesis and Anti‐Inflammation in Chronic Subdural Hematoma Rat Model

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