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Deep 16S rDNA Sequencing of Chronic Subdural Hematomas Suggests Involvement of Bacterial Infection in Recurrences

Johanna Mohr1, Anne Albers1, Frieder Schaumburg2

  • 1Institute of Neuropathology, University Hospital Münster, Münster , Germany.

Neurosurgery
|September 29, 2025
PubMed
Abstract

Insights

Bacterial DNA was detected in recurrent chronic subdural hematoma (CSDH) cases, suggesting a role in CSDH recurrence. Further studies are needed to explore antimicrobial or anti-inflammatory treatments to reduce CSDH recurrence.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Genomics

Background:

  • Chronic subdural hematoma (CSDH) is a common neurosurgical condition characterized by inflammation and angiogenesis.
  • Recurrence rates for CSDH remain high despite surgical interventions.
  • Subclinical bacterial presence is hypothesized to contribute to CSDH recurrence.

Purpose of the Study:

  • To investigate the presence of bacteria in the outer membranes of chronic subdural hematomas.
  • To identify associated histological and transcriptomic changes in CSDH outer capsules.
  • To explore the potential role of bacteria in CSDH recurrence.

Main Methods:

  • Analysis of 39 CSDH outer-capsule specimens from 19 patients using ultra-deep Nanopore 16S rDNA profiling.
  • Histomorphology assessment including Gram staining, lipopolysaccharide immunohistochemistry, and immune-cell quantification.
  • RNA sequencing (RNA-seq) on 3 matched primary-recurrent CSDH pairs for differential gene expression and pathway analysis.

Main Results:

  • Bacterial DNA was exclusively detected in recurrent CSDH lesions (4/22 patients), not in primary cases (P = .02).
  • Identified bacterial genera included Staphylococcus, Neisseria, Prevotellamassilia, and Paracoccus.
  • Transcriptomic analysis revealed distinct profiles between primary and recurrent CSDH, with upregulation of Toll-like receptor 4 and pathways related to development and wound healing.

Conclusions:

  • The presence of bacterial DNA in a subset of recurrent CSDH suggests a potential role for bacteria in CSDH recurrence.
  • Histological analysis did not reveal significant differences in immune cell infiltration between primary, recurrent, or infected CSDH.
  • Further research is warranted to investigate antimicrobial or anti-inflammatory strategies for reducing CSDH recurrence.
Keywords:
Bacterial infectionChronic subdural hematomaMetagenomicsMolecular diagnosticsNanopore sequencing

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