AI Article Synopsis

  • This study investigates the complex mechanisms underlying chronic subdural hematoma (CSDH) by comparing cortical atrophy in 190 CSDH patients with 190 healthy controls using CT scans and a newly developed Relative Cortical Atrophy (RCA) index.
  • The study also introduces ultrastructural analyses of CSDH, revealing a higher presence of newly formed blood vessels within the inner membrane and signs of chronic inflammation.
  • Findings suggest that cortical atrophy may initiate the pathological processes associated with CSDH, as indicated by correlations between the RCA index and various clinical and radiological parameters.

Article Abstract

Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975247PMC
http://dx.doi.org/10.1038/s41598-023-30135-8DOI Listing

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