Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Neovascularization in Outer Membrane of Chronic Subdural Hematoma : A Rationale for Middle Meningeal Artery Embolization

  • Hyun Kim (Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine or College of Pharmacy, Seoul National University) ;
  • Yoori Choi (Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine or College of Pharmacy, Seoul National University) ;
  • Youngsun Lee (Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine or College of Pharmacy, Seoul National University) ;
  • Jae-Kyung Won (Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sung Ho Lee (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Minseok Suh (Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Dong Soo Lee (Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine or College of Pharmacy, Seoul National University) ;
  • Hyun-Seung Kang (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Won-Sang Cho (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Gi Jeong Cheon (Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2023.05.26
  • Accepted : 2023.09.25
  • Published : 2024.03.01
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Abstract

Objective : Chronic subdural hematomas (cSDHs) are generally known to result from traumatic tears of bridging veins. However, the causes of repeat spontaneous cSDHs are still unclear. We investigated the changes in vasculature in the human dura mater and outer membrane (OM) of cSDHs to elucidate the cause of their spontaneous repetition. Methods : The dura mater was obtained from a normal control participant and a patient with repeat spontaneous cSDHs. The pathological samples from the patient included the dura mater and OM tightly adhered to the inner dura. The samples were analyzed with a particular focus on blood and lymphatic vessels by immunohistochemistry, 3-dimensional imaging using a transparent tissue clearing technique, and electron microscopy. Results : The dural border cell (DBC) layer of the dura mater and OM were histologically indistinguishable. There were 5.9 times more blood vessels per unit volume of tissue in the DBC layer and OM in the patient than in the normal control. The DBC layer and OM contained pathological sinusoidal capillaries not observed in the normal tissue; these capillaries were connected to the middle meningeal arteries via penetrating arteries. In addition, marked lymphangiogenesis in the periosteal and meningeal layers was observed in the patient with cSDHs. Conclusion : Neovascularization in the OM seemed to originate from the DBC layer; this is a potential cause of repeat spontaneous cSDHs. Embolization of the meningeal arteries to interrupt the blood supply to pathological capillaries via penetrating arteries may be an effective treatment option.

Keywords

Acknowledgement

This research was supported by the National Research Foundation of Korea Grant funded by the Korea Government funded by the Korea Government (No. NRF-2020R1A2C2101069, NRF-2020M2D9A1093988, 2020R1A2C2011428). And this work was supported by the New Faculty Startup Fund from Seoul National University (800-20200264), and also supported by a grant no 0420210280 from the SNUH Research. And this research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and Korea Dementia Research Center (KDRC), funded by the Ministry of Health & Welfare and Ministry of science and ICT, Republic of Korea (No. HU21C2273), and a grant of the KHIDI, funded by the Ministry of Health & Welfare, Republic of Korea (RS-2023-00262321).

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