Abstract
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.
Highlights
A chronic subdural hematoma (CSDH) is a collection of blood, layered between the surface of the brain and dura.[1]
Various factors have been associated with requiring reoperation (RrR), including post-operative hematoma volume,[11] imaging appearance,[8,11] and concentration of angiogenic factors,[12,13,14,15] there remains considerable uncertainty regarding the prediction of RrR due to variability between studies
Recurrence requiring reoperation based on eosinophilic infiltration and imaging classification A dense eosinophilic infiltrate was observed in 22.2% of cases; the remainder either had no eosinophil infiltrate at all or a sparse infiltrate
Summary
A chronic subdural hematoma (CSDH) is a collection of blood, layered between the surface of the brain and dura.[1]. Despite the fact that evacuation of a CSDH is a relatively common and routine neurosurgical procedure, recurrence requiring reoperation (RrR) has been reported in 3–30% of cases, with most in the 20% range.[7,8,9,10] Over the past several decades, numerous studies have sought to identify factors associated with recurrence, in hopes of predicting which patients should be monitored more closely in the post-operative period. Various factors have been associated with RrR, including post-operative hematoma volume,[11] imaging appearance,[8,11] and concentration of angiogenic factors,[12,13,14,15] there remains considerable uncertainty regarding the prediction of RrR due to variability between studies
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