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Morphological Aspects of the Traumatic Chronic Subdural Hematoma Capsule: SEM Studies

  • Marek Moskała (a1), Igor Gościński (a1), Józef Kałuża (a2), Jarosław Polak (a1), Mariusz Krupa (a1), Dariusz Adamek (a2), Kazimierz Pityński (a3) and Adam J. Miodoński (a4)...
Abstract

The morphology of the outer and inner membranes of traumatic chronic subdural hematomas (CSDHs) surgically removed from eight patients was investigated by scanning electron microscopy (SEM). Hematomas were divided into three groups based on time that had passed from the initiation of trauma to surgery. Structure of the CSDHs showed gradual morphological changes of the developing hematoma capsule. They initially included angiogenic and aseptic inflammatory reactions followed by progressive involvement of fibroblasts—proliferating and producing collagen fibrils. Numerous capillaries suggesting formation of new blood vessels were observed mainly in young hematomas removed between 15 and 21 days after trauma. In “older” hematomas (40 days after trauma), more numerous capillaries and thin-walled sinusoids were accompanied by patent, larger diameter blood vessels. Within the fibrotic outer membrane of the “oldest” hematoma capsules (60 or more days after trauma), especially in the area over the hematoma cavity, blood vessels were frequently occluded by clots. The results suggest dynamic changes in cellular and vascular organization of traumatic CSDH capsules paralleling the progression in hematoma age.

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Corresponding author. E-mail: orlkrakow@su.krakow.pl
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REFERENCES

Allen, D.J. & Didio, L.J.A. (1977). Scanning and transmission electron microscopy of the encephalic meninges in dog. J Submicr Cytol 9, 122.
Apfelbaum, R.I., Guthkelch, A.N. & Shulman, K. (1974). Experimental production of subdural hematomas. J Neurosurg 40, 336346.
Fredrickson, R.G. (1991). The subdural space interpreted as a cellular layer of meninges. Anat Rec 230, 3851.
Friede, R.L. (1971). Incidence and distribution of neomembranes of dura mater. J Nurol Neurosurg Psychiat 34, 439446.
Friede, R.L. & Schachenmayer, W. (1978). The origin of subdural neomembranes. II. Fine structure of neomembranes. Amer J Pathol 92, 6984.
Fujisawa, H., Ito, H., Kashigawi, S., Nomura, S. & Toyosawa, M. (1995). Kallikrein-kinin system in chronic subdural haematomas: Its role in vascular permeability and regulation of fibrinolysis and coagulation. J Neurol Neurosurg Psychiat 59, 388394.
Fujisawa, H., Ito, H., Saito, K., Ikeda, K., Nitta, H. & Yamashita, J. (1991). Immunohistochemical localization of tissue-type plasminogen activator in the lining wall of chronic subdural hematoma. Surg Neurol 35, 441445.
Golden, J., Frim, D.M., Chapman, P.H. & Vonsattel, J.P. (1994). Marked tissue eosinophilia within organizing chronic subdural hematoma. Surg Neurol 35, 441445.
Haines, D.E., Harkley, H.L. & Al-Mefty, O. (1993). The “subdural” space: New look at an outdated concept. Neurosurgery 32, 111120.
Hirashima, Y., Endo, S., Hayashi, N., Karasawa, K., Nojima, S. & Takaku, A. (1995). Platelet-Activating Factor (PAF) and the formation of chronic subdural hematoma. Acta Neurochir (Wien) 137, 1518.
Kerber, C.W. & Newton, T.H. (1973). The macro and microvasculature of the dura mater. Neuroradiology 6, 175179.
Kischer, C.W. (1993). Contribution of electron microscopy to the study of the hypertrophic scar and related lesions. Scan Microsc 7, 921931.
Klika, E. & Richter, M. (1989). SEM of subdural space in mammals. In Cells and Tissues: A Three-Dimensional Approach by Modern Techniques in Microscopy, Motta, P.M. (Ed.), pp. 389393. New York: Alan R. Liss, Inc.
Kovacs, E. & DiPietro, L. (1994). Fibrogenic cytokines and connective tissue production. FASEB J 8, 854861.
Krupp, W.F. & Jans, P.J. (1995). Treatment of chronic subdural hematoma with burr hole craniostomy and closed system drainage. Brit J Neurosurg 9, 619627.
Labadie, E.L. & Glover, D. (1976). Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparison of subcutaneous hematoma in rats with subdural hematoma in man. J Neurosurg 45, 382392.
Li, W.-Y., Chong, S.S.N., Huang, E.Y. & Tuan, T.-L. (2003). Plasminogen activator/plasmin system: A major player in wound healing? Wound Rep Reg 11, 239247.
Löfgren, J. (1986). Traumatic intracranial hematomas: Pathological aspects on their course and treatment. Acta Neurochir Suppl 36, 151154.
Lopes, C.A.S. & Mair, W.G.P. (1974). Ultrastucture of the arachnoid membrane in man. Acta Neuropath (Berl.) 28, 167173.
Markwalder, T.-M. (1981). Chronic subdural hematomas: A review. J Neurosurg 54, 637645.
Murakami, H., Hirose, Y., Sagoh, M., Shimizu, K., Kojima, M., Gotoh, K., Mine, Y., Hayaschi, T. & Kawase, T. (2002). Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96, 877884.
Nicholas, D.S. & Weller, R.O. (1988). The fine anatomy of the human spinal meninges. J Neurosurg 69, 276282.
Nowicki, P. (1980). Zależność między wiekiem krwiaka podtwardówkowego a obrazem morfologicznym jego torebki. Neoropat Pol XVIII, 151166.
Orlin, J.R., Osen, K.K. & Hovig, T. (1991). Subdural compartment in pig: A morphologic study with blood and horseradish peroxydase infused subdurally. Anat Rec 230, 2237.
Reina, M.A., Casasola, O.D.L., Lopez, A., De Andres, J.A., Mora, M. & Fernandez, A. (2002). The origin of the spinal subdural space: Ultrastructure findings. Anesth Analg 94, 991995.
Sato, A. & Suzuki, J. (1975). Ultrastructural observation of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43, 569578.
Schachenmayer, W. & Friede, R.L. (1978). The origin of subdural neomembranes. I. Fine structure of the dura-arachnoid interface in man. Amer J Pathol 92, 5368.
Shono, T., Inamura, T., Morioka, T., Matsumoto, K., Suzuki, S., Ikezaki, K., Iwaki, T. & Fukui, M. (2001). Vascular endothelial growth factor in chronic subdural haematomas. J Clin Neurosci 8, 411415.
Stoodley, M. & Weir, B. (2000). Contents of chronic subdural hematoma. Neurosurg Clin N Am 11, 425434.
Suzuki, M., Endo, S., Inada, K., Kudo, A., Kitakami, A., Kuroda, K. & Ogawa, A. (1998). Inflammatory cytokines locally elevated in chronic subdural haematoma. Acta Neurochir 140, 5155.
Vaquero, J., Zurita, M. & Cincu, R. (2002). Vascular endothelial growth-permeability factor in granulation tissue of chronic subdural haematomas. Acta Neurochir (Wien) 144, 343347.
Watanabe, S., Shimada, H. & Ishii, S. (1972). Production of clinical form chronic subdural hematoma in experimental animal. J Neurosurg 37, 552561.
Weigel, R., Schilling, L. & Schmiedek, P. (2001). Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): Evidence for an angiogenic disease. Acta Neurochir (Wien) 143, 811819.
Wilberger, J.E. (2000). Pathophysiology of evolution and recurrence of chronic subdural hematoma. Neurosurg Clin N Am 11, 435438.
Yamashima, T., Kubota, T. & Yamamoto, S. (1985). Eosinophil degranulation in the capsule of chronic subdural hematomas. J Neurosurg 62, 257260.
Yamashima, T. & Yamamoto, S. (1984). How do vessels proliferate in the capsule of a chronic subdural hematoma? Neurosurgery 15, 672678.
Yamashima, T. & Yamamoto, S. (1985). The origin of inner membranes in chronic subdural hematomas. Acta Neuropathol (Berl) 67, 219225.
Yamashima, T., Yamamoto, S. & Friede, R.L. (1983). The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg 59, 298303.
Zagzag, D. & Capo, V. (2002). Angiogenesis in the central nervous system: A role for vascular endothelial and growth factor/vascular permeability factor and tenascin-C. Common molecular effectors in cerebral neoplastic and non-neoplastic “angiogenic disesases.” Histol Histopathol 17, 301321.
Zumkeller, M., Hollerhage, H.G. & Deitz, H. (1997). Treatment outcome in patients with chronic subdural hematoma with reference to age and concurrent diseases. Wien Med Wochenschr 147, 5562.
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Microscopy and Microanalysis
  • ISSN: 1431-9276
  • EISSN: 1435-8115
  • URL: /core/journals/microscopy-and-microanalysis
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