Presence of smooth-muscle cells in the subdural neomembrane

The authors encountered a case of chronic subdural hematoma of which the subdural neomembrane (SN) showed numerous spindle-shaped cells identified as smooth-muscle cells (SMC's) by electron microscopy. On reexamination of 214 cases from the files, SMC's were found with light microscopy in seven cases. In these cases, the SN was well organized (collagenized). In three additional cases examined with both light and electron microscopy, SMC's were not apparent with light microscopy. However, in all cases, cells with ultrastructural features of both fibroblasts and SMC's were observed. Well formed SMC's were found in two additional cases of well organized membrane. Based on these observations, it is concluded that the presence of SMC's in the SN is not a rare phenomenon. The possible origin of SMC's in the SN and their pathological significance to the organizing process of chronic subdural hematoma are discussed.