• World Neurosurg · Nov 2024

    Immunoprofile of radiological Chronic Subdural Hematoma subtypes.

    • Anders Schack, Rønn JensenThorbjørn SørenTSDepartment of Neurosurgery, Rigshospitalet, Copenhagen, Denmark., Tina Binderup, and Kåre Fugleholm.
    • Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark. Electronic address: andersemilschack@gmail.com.
    • World Neurosurg. 2024 Nov 14; 193: 815824815-824.

    ObjectiveThis study aimed to investigate the immunologic profile of chronic subdural hematoma (CSDH) subtypes based on their radiologic appearances, with a focus on comparing the membranous CSDH to other subtypes.MethodsWe prospectively analyzed 170 CSDH cases from 138 patients, categorizing them into "Membranous" and 'Other' subtypes based on computed tomography scans. Samples were collected from the subdural fluid and systemic blood and analyzed for a panel of inflammatory markers. Demographic data, clinical characteristics, and time since trauma were also assessed.ResultsTime since trauma to diagnostic computed tomography was significantly longer for the "membranous" subtype (P = 0.001). 'Membranous" CSDH exhibited a distinct immunoprofile, including lower hemoglobin levels (P = 0.0002) and higher concentrations of matrix metallopeptidase 9 (P = 0.005) and interleukin-8 (IL-8) (P < 0.0001). Additionally, "Membranous" CSDH showed elevated levels of interferon gamma-induced protein 10, monokine induced by gamma interferon, and uPAR compared to 'Other' subtypes, with significant correlations between interferon gamma-induced protein 10 and monocyte chemoattractant protein-1 (P = 0.013), monokine induced by gamma interferon (P = 0.002), and urokinase-type plasminogen activator receptor (P = 0.006). IL-8 levels also correlated significantly with monocyte chemoattractant protein-1 (P = 0.02), suggesting distinct inflammatory pathways in the "Membranous" subtype.ConclusionsThis study demonstrates that CSDH subtypes, particularly the "Membranous" subtype, possess a distinct immunologic profile. These findings provide novel insights into CSDH pathophysiology. The unique inflammatory landscape of "Membranous" CSDH, marked by elevated matrix metallopeptidase 9 and IL-8 levels, may contribute to its chronic nature.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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