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Assessment of Cerebral Autoregulation in the Perifocal Zone of a Chronic Subdural Hematoma
Svetlana Trofimova1, Alex Trofimov2, Antony Dubrovin1
1Department of Neurosurgery, Privolzhsky Research Medical University, Nizhniy Novgorod, Russia.
Insights
Conservative treatment for chronic subdural hematoma (CSDH) lacks strong evidence. This study found that microcirculation and autoregulation in the CSDH zone indicate preserved cerebral blood flow, offering insights into CSDH mechanisms.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Conservative treatment for chronic subdural hematoma (CSDH) relies on limited evidence.
- Understanding CSDH development requires evaluating microcirculation and autoregulation near the hematoma.
Purpose of the Study:
- To assess microcirculation and autoregulation in the perifocal CSDH zone.
- To elucidate the mechanisms underlying CSDH development.
Main Methods:
- Cerebral microcirculation was evaluated using brain perfusion computed tomography (PCT) within 24 hours.
- Perfusion parameters were quantified in the cortex adjacent to the CSDH and in the contralateral hemisphere.
- PCT data were analyzed with and without excluding large-vessel voxels ('remote vessels' - RVs).
Main Results:
- Analysis without RVs showed increased cerebral blood volume and flow in the contralateral hemisphere compared to normal values.
- Analysis with RVs revealed no significant changes in microcirculatory blood flow in the contralateral cortex.
- These findings suggest that microcirculatory flow is maintained despite the hematoma.
Conclusions:
- Preserved microcirculatory blood flow perfusion in patients with CSDH suggests intact cerebral blood flow autoregulation.
- This indicates that the brain can compensate to some extent in the presence of a chronic subdural hematoma.
Introduction:
The knowledge of conservative treatment modalities for a chronic subdural hematoma (CSDH) is still based on low-grade evidence. The purpose of this study was to evaluate the condition of the microcirculation and autoregulation in the perifocal CSDH zone for understanding of the mechanism of CSDH development.
Methods:
Cerebral microcirculation was evaluated in patients with the aid of brain perfusion computed tomography (PCT) within the first day. Perfusion parameters were assessed quantitatively in the cortex zone adjacent to the CSDH and in a similar zone of the contralateral hemisphere. The same PCT data were assessed quantitatively without and with use of a perfusion calculation mode excluding large-vessel voxels ("remote vessels" (RVs)) in the first and second methods, respectively.
Results:
The first method of analysis of a similar zone in the contralateral hemisphere revealed significant increases in cerebral blood volume and cerebral blood flow (P < 0.01) in comparison with normal values. Use of the second method with RVs showed no significant changes in perfusion parameters in microcirculatory blood flow in the cortex on the side contralateral to the hematoma.
Conclusion:
The persistence of microcirculatory blood flow perfusion reflects preservation of cerebral blood flow autoregulation in patients with a CSDH.
