Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-17T21:28:19.770Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 April 2007

Marek Moskała ,
Igor Gościński ,
Józef Kałuża ,
Jarosław Polak ,
Mariusz Krupa ,
Dariusz Adamek ,
Kazimierz Pityński  and
Adam J. Miodoński
Marek Moskała
Affiliation:
Department of Neurotraumatology, Jagiellonian University Medical College, Krakow, Poland
Igor Gościński
Affiliation:
Department of Neurotraumatology, Jagiellonian University Medical College, Krakow, Poland
Józef Kałuża
Affiliation:
Department of Neuropathology, Jagiellonian University Medical College, Krakow, Poland
Jarosław Polak
Affiliation:
Department of Neurotraumatology, Jagiellonian University Medical College, Krakow, Poland
Mariusz Krupa
Affiliation:
Department of Neurotraumatology, Jagiellonian University Medical College, Krakow, Poland
Dariusz Adamek
Affiliation:
Department of Neuropathology, Jagiellonian University Medical College, Krakow, Poland
Kazimierz Pityński
Affiliation:
Department of Gynecology & Oncology, Jagiellonian University Medical College, Krakow, Poland
Adam J. Miodoński
Affiliation:
Laboratory of Scanning Electron Microscopy, Jagiellonian University Medical College, Krakow, Poland
Get access

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.

Keywords

CSDHtraumatic subdural hematomaneomembrane morphologyscanning electron microscopySEM
Type
BIOLOGICAL APPLICATIONS
Information
Microscopy and Microanalysis , Volume 13 , Issue 3 , June 2007 , pp. 211 - 219
Copyright
© 2007 Microscopy Society of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Allen, D.J. & Didio, L.J.A. (1977). Scanning and transmission electron microscopy of the encephalic meninges in dog. J Submicr Cytol 9, 1–22.Google Scholar
Apfelbaum, R.I., Guthkelch, A.N. & Shulman, K. (1974). Experimental production of subdural hematomas. J Neurosurg 40, 336–346.Google Scholar
Fredrickson, R.G. (1991). The subdural space interpreted as a cellular layer of meninges. Anat Rec 230, 38–51.Google Scholar
Friede, R.L. (1971). Incidence and distribution of neomembranes of dura mater. J Nurol Neurosurg Psychiat 34, 439–446.Google Scholar
Friede, R.L. & Schachenmayer, W. (1978). The origin of subdural neomembranes. II. Fine structure of neomembranes. Amer J Pathol 92, 69–84.Google Scholar
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, 388–394.Google Scholar
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, 441–445.Google Scholar
Golden, J., Frim, D.M., Chapman, P.H. & Vonsattel, J.P. (1994). Marked tissue eosinophilia within organizing chronic subdural hematoma. Surg Neurol 35, 441–445.Google Scholar
Haines, D.E., Harkley, H.L. & Al-Mefty, O. (1993). The “subdural” space: New look at an outdated concept. Neurosurgery 32, 111–120.Google Scholar
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, 15–18.Google Scholar
Kerber, C.W. & Newton, T.H. (1973). The macro and microvasculature of the dura mater. Neuroradiology 6, 175–179.Google Scholar
Kischer, C.W. (1993). Contribution of electron microscopy to the study of the hypertrophic scar and related lesions. Scan Microsc 7, 921–931.Google Scholar
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. 389–393. New York: Alan R. Liss, Inc.
Kovacs, E. & DiPietro, L. (1994). Fibrogenic cytokines and connective tissue production. FASEB J 8, 854–861.Google Scholar
Krupp, W.F. & Jans, P.J. (1995). Treatment of chronic subdural hematoma with burr hole craniostomy and closed system drainage. Brit J Neurosurg 9, 619–627.Google Scholar
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, 382–392.Google Scholar
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, 239–247.Google Scholar
Löfgren, J. (1986). Traumatic intracranial hematomas: Pathological aspects on their course and treatment. Acta Neurochir Suppl 36, 151–154.Google Scholar
Lopes, C.A.S. & Mair, W.G.P. (1974). Ultrastucture of the arachnoid membrane in man. Acta Neuropath (Berl.) 28, 167–173.Google Scholar
Markwalder, T.-M. (1981). Chronic subdural hematomas: A review. J Neurosurg 54, 637–645.Google Scholar
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, 877–884.Google Scholar
Nicholas, D.S. & Weller, R.O. (1988). The fine anatomy of the human spinal meninges. J Neurosurg 69, 276–282.Google Scholar
Nowicki, P. (1980). Zależność między wiekiem krwiaka podtwardówkowego a obrazem morfologicznym jego torebki. Neoropat Pol XVIII, 151–166.Google Scholar
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, 22–37.Google Scholar
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, 991–995.Google Scholar
Sato, A. & Suzuki, J. (1975). Ultrastructural observation of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43, 569–578.Google Scholar
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, 53–68.Google Scholar
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, 411–415.Google Scholar
Stoodley, M. & Weir, B. (2000). Contents of chronic subdural hematoma. Neurosurg Clin N Am 11, 425–434.Google Scholar
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, 51–55.Google Scholar
Vaquero, J., Zurita, M. & Cincu, R. (2002). Vascular endothelial growth-permeability factor in granulation tissue of chronic subdural haematomas. Acta Neurochir (Wien) 144, 343–347.Google Scholar
Watanabe, S., Shimada, H. & Ishii, S. (1972). Production of clinical form chronic subdural hematoma in experimental animal. J Neurosurg 37, 552–561.Google Scholar
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, 811–819.Google Scholar
Wilberger, J.E. (2000). Pathophysiology of evolution and recurrence of chronic subdural hematoma. Neurosurg Clin N Am 11, 435–438.Google Scholar
Yamashima, T., Kubota, T. & Yamamoto, S. (1985). Eosinophil degranulation in the capsule of chronic subdural hematomas. J Neurosurg 62, 257–260.Google Scholar
Yamashima, T. & Yamamoto, S. (1984). How do vessels proliferate in the capsule of a chronic subdural hematoma? Neurosurgery 15, 672–678.Google Scholar
Yamashima, T. & Yamamoto, S. (1985). The origin of inner membranes in chronic subdural hematomas. Acta Neuropathol (Berl) 67, 219–225.Google Scholar
Yamashima, T., Yamamoto, S. & Friede, R.L. (1983). The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg 59, 298–303.Google Scholar
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, 301–321.Google Scholar
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, 55–62.Google Scholar