Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence

Katano, Hiroyuki; Kamiya, Kazuko; Mase, Mitsuhito; Tanikawa, Motoki; Yamada, Kazuo

doi:10.3171/jns.2006.104.1.79

Cited by 48 publications

(31 citation statements)

References 30 publications

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“…In this respect, it has been shown that the hematoma fluid contains high concentrations of coagulation factors (plas minogen activator) 14 and inflammatory factors (vascular endothelial growth factor), 33 and both factors are shown to be predictive of recurrence. 19,30 These mechanisms remain speculative, however.…”

Section: Discussionmentioning

confidence: 99%

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Liu

Bakker

Groen

2014

JNS

254

151

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Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21–0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21–1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.

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Section: Discussionmentioning

confidence: 99%

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Liu

Bakker

Groen

2014

JNS

254

151

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“…When CSF or extravasated blood gathers into the restricted area of the dural border cell layer [3][4][5], it evokes local aseptic inflammatory- [6][7][8][9][10] and inflammationinduced angiogenic reactions [8,[11][12][13][14][15][16][17]. The result is production of granulation tissue, consisting of numerous newly formed and permeable blood vessels, inflammatory cells, proliferating fibroblasts corresponding to ''boundary cells'' and smooth muscle cells, that takes place primarily on the inner dural surface [3,[18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…This results in formation of a capsule, also called CSDH neomembranes, within 3 to 4 weeks after trauma. These processes are accompanied by abnormality in the local coagulo-fibrinolytic system [12,[21][22][23][24][25]. Thus, CSDH is currently considered a circumscribed chronic self-perpetuating inflammatory disorder that involves the dura mater; however, local immune responses in this disorder are still not clear.…”

Section: Introductionmentioning

confidence: 99%

Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

et al. 2012

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The innate immune responses occur both locally at the site of CSDH, as well as systematically in patients with CSDH. The local hyper-inflammatory and low anti-inflammatory responses exist simultaneously. The findings suggest poorly coordinated innate immune responses at the site of CSDH that may lead to propagating of local inflammatory process and basically contribute to formation and progression of CSDH.

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“…19) On the other hand, CSDH is also associated with an imbalance of factors involved in the regulation of coagulation and fibrinolysis. 8,10) The combination of fragile and permeable microvessels with coagulopathy is believed to be one of the causes of CSDH.…”

Section: Introductionmentioning

confidence: 99%

Involvement of Hypoxia-Inducible Factor-1.ALPHA. and Vascular Endothelial Growth Factor in the Mechanism of Development of Chronic Subdural Hematoma

Nanko

Tanikawa

Mase

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Vascular endothelial growth factor (VEGF), a potent inducer of angiogenesis and vascular permeability in diverse physiological and pathological conditions, may be involved in the pathophysiology of chronic subdural hematoma (CSDH). The present study investigated the source and mechanisms for the induction of VEGF in CSDH by measuring the concentration of VEGF in the hematoma of 102 patients (122 hematomas) using the enzyme-linked immunosorbent assay technique. The relationship between the VEGF concentration in hematoma and the intrahematoma membranous structure confirmed by preoperative T 2 *-weighted magnetic resonance image was examined in 46 of these patients. VEGF and hypoxia-inducible factor-1a (HIF-1a) expression was immunohistochemically studied and microvessel density (MVD) in the outer membrane was identified using anti-CD31 antibody in 30 patients. VEGF and HIF-1a were positive in the outer membranes of all 30 patients. VEGF expression was significantly correlated to HIF-1a expression (r s ＝ 0.651, p ＝ 0.0084) and VEGF concentration in the hematoma (r s ＝ 0.654, p ＝ 0.0013). VEGF concentration in layered hematomas, which have intrahematoma membranous structure, was significantly higher than in non-layered hematomas (p º 0.01). Although MVDs of the outer membranes were comparable to those described in tumors, there was no significant relationship with VEGF expression. The present study suggests that VEGF in CSDH, which may be induced in the neomembrane by HIF-1 release, may give rise to the excessive development of fragile microvessels and hyperpermeability, resulting in the enlargement of CSDH.

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Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence

Cited by 48 publications

References 30 publications

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

Involvement of Hypoxia-Inducible Factor-1.ALPHA. and Vascular Endothelial Growth Factor in the Mechanism of Development of Chronic Subdural Hematoma

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