Davidson Benjamin, Narvacan Karl, Munoz David G, Rotondo Fabio, Kovacs Kalman, Zhang Stanley, Cusimano Michael D
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Pathology, Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada.
Neurotrauma Rep. 2021 Feb 8;2(1):76-83. doi: 10.1089/neur.2020.0036. eCollection 2021.
Chronic subdural hematomas (CSDHs) are a common neurological condition, whose incidence is expected to increase with an aging population. Although surgical evacuation is the mainstay of treatment, it results in a recurrence requiring reoperation (RrR) in 3-30% of cases. Recurrence is thought to be driven by a combination of inflammatory and angiogenic processes occurring within the CSDH outer membrane. Pathological specimens of 72 primary CSDHs were examined for eosinophilic infiltrate. For each case, the pre-operative computed tomography (CT) scan was graded according to the Nakaguchi grading scheme as homogeneous, laminar, separated, or trabecular. Rate of RrR was compared based on eosinophilic infiltrate and CT grade. A dense eosinophilic infiltrate was observed in 22% of specimens. The rate of RrR among specimens with a dense eosinophilic infiltrate was 0%, whereas it was 14.3% among specimens without a dense eosinophilic infiltrate. Incidence among homogeneous, laminar, separated, and trabecular CT subtypes was 4%, 27%, 58%, and 24%, respectively. A dense eosinophilic infiltrate found within the outer membrane of a CSDH may be a marker of hematoma maturation, signaling a transition toward healing and fibrosis, and a lower risk of RrR.
慢性硬膜下血肿（CSDHs）是一种常见的神经系统疾病，预计其发病率会随着人口老龄化而增加。尽管手术清除是主要的治疗方法，但仍有3%至30%的病例会复发并需要再次手术（RrR）。复发被认为是由CSDH外膜内发生的炎症和血管生成过程共同驱动的。对72例原发性CSDH的病理标本进行嗜酸性粒细胞浸润检查。对于每例病例，术前计算机断层扫描（CT）扫描根据中口分级方案分为均匀型、层状型、分隔型或小梁型。根据嗜酸性粒细胞浸润和CT分级比较RrR发生率。在22%的标本中观察到密集的嗜酸性粒细胞浸润。有密集嗜酸性粒细胞浸润的标本中RrR发生率为0%，而无密集嗜酸性粒细胞浸润的标本中RrR发生率为14.3%。均匀型、层状型、分隔型和小梁型CT亚型的发生率分别为4%、27%、58%和24%。在CSDH外膜内发现的密集嗜酸性粒细胞浸润可能是血肿成熟的标志，表明向愈合和纤维化的转变，以及较低的RrR风险。
