Colamaria Antonio, Sacco Matteo, Iodice Savino, Fochi Nicola Pio, Carbone Francesco
Department of Neurosurgery, "Riuniti" Hospital, Foggia, Italy.
Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy.
Surg Neurol Int. 2021 Nov 23;12:578. doi: 10.25259/SNI_950_2021. eCollection 2021.
Chronic subdural hematoma (CSDH) represents the most common neurosurgical disease. Given the demographic shift toward an aging population, the overall incidence of this condition is increasing. Nevertheless, clarity in the pathophysiological process is yet to be made. Several etiological mechanisms have been proposed to initiate and consequently promote fluid collection in the subdural space. Traumatic injury of the bridging veins has long been considered the primum movens of the pathology but increasing evidence shows that trauma is not the only factor involved. Along with recent advances we sought to understand the role of the cerebrospinal fluid (CSF) in the buildup of the intense inflammatory reaction that characterizes CSDH.
In the present study, we examined histological features of reactive membranes secondary to extracranial CSF leakage with CSDH-related membranes. Similarity and differences between the specimens were examined by means of light microscopy.
Histological similarities were consistently found between CSDH membranes and reactive membranes secondary to CSF leakage in the extracranial space. Activated histiocytes were highlighted in all specimens along with an intense inflammatory reaction.
CSDH is most likely the result of a complex interaction among different pathophysiological events resulting from both traumatic and inflammatory etiologies. In the present work, we highlight how CSF leakage could be an early factor that leads to a cascade of events that culminates in CSDH formation.
慢性硬膜下血肿（CSDH）是最常见的神经外科疾病。随着人口老龄化，这种疾病的总体发病率正在上升。然而，其病理生理过程仍不明确。已经提出了几种病因机制来启动并进而促进硬膜下腔积液。桥静脉的创伤性损伤长期以来一直被认为是该病理过程的首要动因，但越来越多的证据表明创伤并非唯一涉及的因素。随着近期的进展，我们试图了解脑脊液（CSF）在以CSDH为特征的强烈炎症反应形成过程中的作用。
在本研究中，我们检查了与CSDH相关的膜继发于颅外脑脊液漏的反应性膜的组织学特征。通过光学显微镜检查标本之间的异同。
在CSDH膜与颅外空间脑脊液漏继发的反应性膜之间始终发现组织学相似性。所有标本中均突出显示了活化的组织细胞以及强烈的炎症反应。
CSDH很可能是由创伤性和炎症性病因引起的不同病理生理事件之间复杂相互作用的结果。在本研究中，我们强调了脑脊液漏如何可能是导致一系列最终导致CSDH形成的事件的早期因素。
