Significantly high concentrations of vascular endothelial growth factor in chronic subdural hematoma with trabecular formation

• Published in: Clinical neurology and neurosurgery 2021-03, Vol.202, p.106458-106458, Article 106458
• Main Authors: Takei, Jun, Tanaka, Toshihide, Yamamoto, Yohei, Hatano, Keisuke, Ichinose, Diasuke, Maruyama, Fumiaki, Tochigi, Satoru, Hasegawa, Yuzuru, Murayama, Yuichi
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Angiogenesis; Arachnoid; Biomarkers; Biomarkers - metabolism; Blood; Brain; Chronic subdural hematoma; Classification; Computed tomography; Cytokines; Dura mater; Female; Head injuries; Hematoma; Hematoma, Subdural, Chronic - diagnostic imaging; Hematoma, Subdural, Chronic - metabolism; Hematoma, Subdural, Chronic - pathology; Humans; Inflammation; Male; Meninges; Middle Aged; Minor head injury; Neurology; Pathogenesis; Predictive Value of Tests; Recurrence; Reproducibility of Results; Surgery; Tomography, X-Ray Computed; Trabecular formation; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - metabolism
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106458

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.