Preliminary Studies On Association Between Endoscopic Characteristics And Relevant Cytokines Expression In Complicated Chronic Subdural Hematoma

ObjectiveIn this study,we analyze the endoscopic characteristics of complicated chronic subdural hematoma(CSDH),and evaluate the association with relevant cytokines expression,in order to further elucidate the molecular mechanisms of the development processes of complicated CSDH and visualize the complex structure of the hematoma cavity for the purpose of precise surgical intervention to further improving the surgical efficacy and decreasing the complications of complicated CSDH.MethodsA total of 41 patients diagnosed of complicated CSDH admitted to our hospital from November 2017 to November 2019 were studied and divided into three groups:according to the time interval from head trauma to the day of surgery(preoperative course):short course(<30d);medium course(30-90d);long course(>90d)group,respectively.The clinical data and the endoscopic characteristics of hematoma cavity observed during the endoscopic keyhole surgery were recorded.The outer membrane thickness and bleeding,hematoma liquification ratio,trabecular structure formation,and hematoma cavity septum,were totally analyzed,and the correlation between different endoscopic characteristics and preoperative course formation time of symptomatic CSDH was evaluated,too.Ten milliliter of the liquified hematoma fluid of complicated CSDH,autologous peripheral venous blood from 41 patients and 14 healthy volunteers' venous blood as control were collected respectively.The levels of VEGF,ANG-2,TGF-?1 in these blood samples were detected with ELISA,5x5mm outer membrane of complicated CSDH,with adjacent dura were also colleted for analyzing the expression of VEGFR-2 and TIE-2 and CD31-marked microvessel density(CD31-MVD)of complicated CSDH by immunohistochemistry.Statistical analysis of the correlation between the expression levels of various cytokines and microvessel density with different endoscopic characteristic structures was performed.ResultsThe endoscopic characteristics of 41 complicated CSDH are as follows:1.The hematoma outer membrane is divided according to its thickness(22 cases with thin membrane,15 cases with medium thickness membrane,and 4 cases with thick membrane);2.Bleeding degree of the outer membrane(Mild degree 14 cases,moderate 8 cases,severe 3 cases);3.Hematoma liquification degree(?50%in 23 cases,<50%in 18 cases);4.There are 12 cases with hematoma cavity septum;5.In the hemaroma cavity,trabecular structure can be observed in a total of 26 cases.The incidence rate of membrane bleeding and bleeding degree decrease gradually with the increase of CSDH formation time(p<0.05).The thickness of the membrane increased with the increase of CSDH formation time(p<0.05),In the cases of hematoma liquification degree less than 50%,in the short course cases and the long course cases are more than the middle course cases(p<0.05).4.The formation of trabecular structures and septum in the hematoma cavity was positively correlated with CSDH formation time.(p<0.05).The levels of VEGF,TGF-?1,and ANG-2 in complex CSDH hematoma fluid were higher than those of peripheral venous blood from patients and healthy volunteers(p<0.01).The levels of VEGF and ANG-2 in CSDH hematoma fluid were positively correlated with the time of CSDH formation and the degree of membrane hemorrhage(p<0.05).The level of TGF-?1 in CSDH hematoma fluid was positively correlated with the time of CSDH formation,the thickness of the membrane,the proportion of unliquefied hematoma,and fibrous hyperplasia(trabecular or septum formation)in the hematoma cavity(p<0.05).The expression of VEGFR-2,TIE-2 and CD31-MVD in the outer membrane were higher than that of the patient's dura mater(p<0.01);the expression of VEGFR-2,TIE-2 and CD31-MVD in the outer membrane of CSDH was positively related to the bleeding degree(p<0.05).Conclusion1.Different endoscopic features can be observed under the endoscopic keyhole surgery on complicated CSDH patients.The thickness of outer membrane,the bleeding degree of membrane,the degree of hematoma liquification,the septum,and the trabecular structure formation can be applied as the main evaluation indicators.2.With the increase of the preoperative course of CSDH,the thickness of the hematoma membrane increases,the degree of fibrous hyperplasia in the cavity gradually increases,and the degree of membrane bleeding gradually decreases.3.Some cytokines,such as VEGF/VEGFR-2,ANG-2/TIE-2,and TGF-?1 are involved in the occurrence and development of CSDH.4.VEGF/VEGFR-2 and ANG-2/TIE-2 are closely related to the bleeding degree of outer membrane.TGF-?1 is closely related to the thickness of the membrane?the fibrous hyperplasia in the hematoma cavity and the degree of liqiefication of the hematoma.