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Developing a model of chronic subdural hematoma
Jingyang Tang1, Jinglu Ai, R Loch Macdonald
1Division of Neurosurgery, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, and Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Insights
Chronic subdural hematoma (CSDH) is a common neurosurgical issue in the elderly. Developing an animal model for CSDH could advance understanding of its causes and lead to better treatments.
Area of Science:
- Neurosurgery
- Pathology
- Geriatrics
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly in the aging population.
- CSDH is characterized by a liquefied hematoma in the subdural space, typically over three weeks old and encapsulated.
- While minor head trauma is a common trigger, the precise pathogenesis, including theories on osmotic pressure and recurrent bleeding, remains incompletely understood.
Purpose of the Study:
- To highlight the need for a better understanding of CSDH pathogenesis.
- To emphasize the limitations of current surgical treatments, including invasiveness and recurrence rates.
- To propose the development of a reproducible animal model to facilitate CSDH research.
Main Methods:
- Review of existing literature on CSDH pathology and pathogenesis.
- Analysis of current treatment strategies and their limitations.
- Identification of knowledge gaps in understanding CSDH mechanisms.
Main Results:
- CSDH pathogenesis is complex, involving angiogenesis, inflammation, coagulation, and fibrinolysis, but precise mechanisms are unclear.
- Current treatments are primarily surgical and carry risks of recurrence.
- Existing theories on pathogenesis, such as osmotic pressure differences, lack strong supporting evidence.
Conclusions:
- A deeper understanding of CSDH pathogenesis is crucial for developing improved treatments.
- An easily reproducible and representative animal model is needed to advance research.
- Such a model could significantly aid in exploring CSDH pathogenesis and developing novel therapeutic options.
Abstract:
Chronic subdural hematoma (CSDH) is a common neurosurgical condition that has a high incidence in the increasing elderly population of many countries. Pathologically, it is defined as a persistent liquefied hematoma in the subdural space more than 3 weeks old that is generally encased by a membraneous capsule. CSDHs likely originate after minor head trauma, with a key factor in its development being the potential for a subdural cavity to permit its expansion within, which is usually due to craniocerebral disproportion. The pathogenesis of CSDH has been attributed to osmotic or oncotic pressure differences, although measurements of these factors in the CSDH fluid do not support this theory. Current belief is that CSDH arises from recurrent bleeding in the subdural space, caused by a cycle of local angiogenesis, inflammation, coagulation and ongoing fibrinolysis. However, because of a lack of detailed knowledge about the precise mechanisms, treatment is often limited to surgical interventions that are invasive and often prone to recurrence. Thus, it is possible that an easily reproducible and representative animal model of CSDH would facilitate research in the pathogenesis of CSDH and aid with development of treatment options.
