Takei Jun, Tanaka Toshihide, Yamamoto Yohei, Hatano Keisuke, Ichinose Diasuke, Maruyama Fumiaki, Tochigi Satoru, Hasegawa Yuzuru, Murayama Yuichi
Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Japan; Department of Neurosurgery, Jikei University School of Medicine, Japan.
Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Japan.
Clin Neurol Neurosurg. 2021 Mar;202:106458. doi: 10.1016/j.clineuro.2020.106458. Epub 2021 Jan 6.
The underlying mechanism of chronic subdural hematoma (CSDH) after minor head injury is complex, probably due to mechanical injury of the arachnoid membrane, hematological coagulopathy, and pathological angiogenesis in the dura caused by inflammatory cytokines including vascular endothelial growth factor (VEGF). To confirm whether VEGF might be a reliable predictive biomarker for the natural history of CSDH, including progression and recurrence, we analyzed the correlation of VEGF concentration in the subdural fluid with CT findings and clinical features, including interval from minor head injury. Based on CT classification by hematoma density, the mean concentration of VEGF in hematoma fluid was found to be highest in the trabecular group, whereas the recurrence of CSDH was most frequent in the separated group in which VEGF concentration was low. There was a significant correlation between VEGF concentration and the CT classification. Furthermore, only in the trabecular group, a significant negative correlation between the VEGF concentration and interval from minor head injury to surgery was observed. These results suggest that VEGF concentration in the hematoma alone could not be a reliable predictive biomarker for the natural history of CSDH including its recurrence. Amongst the classified groups of CSDH, the trabecular group is likely to follow a different time course of VEGF concentration in the hematoma fluid compared to the other three groups.
轻微头部损伤后慢性硬膜下血肿（CSDH）的潜在机制较为复杂，可能是由于蛛网膜机械性损伤、血液凝固异常以及包括血管内皮生长因子（VEGF）在内的炎性细胞因子引起的硬脑膜病理性血管生成所致。为了确定VEGF是否可能是CSDH自然病程（包括进展和复发）的可靠预测生物标志物，我们分析了硬膜下液中VEGF浓度与CT表现及临床特征（包括距轻微头部损伤的时间间隔）之间的相关性。根据血肿密度进行CT分类，发现血肿液中VEGF的平均浓度在小梁状组中最高，而CSDH复发在VEGF浓度较低的分隔组中最为频繁。VEGF浓度与CT分类之间存在显著相关性。此外，仅在小梁状组中，观察到VEGF浓度与从轻微头部损伤到手术的时间间隔之间存在显著负相关。这些结果表明，仅血肿中的VEGF浓度不能作为CSDH自然病程（包括其复发）的可靠预测生物标志物。在CSDH的分类组中，与其他三组相比，小梁状组血肿液中VEGF浓度可能遵循不同的时间进程。
