E-ISSN: 1019-5157
ISSN: 2651-5024
Research
De novo Vessels and BloodBrain Barrier-like Structures in Inner Membranes of Chronic Subdural Hematomas: First Report of Histopathological Basis of Recurrence and Enlargement
Mehmet Kursat Karadag✉ ,
Mete Zeynal ,
Mehmet Hakan Sahin ,
Mehmet Emin Akyuz ,
Sare Altas ,
Ayhan Kanat ,
Abdulkerim Olgun ,
Ali Ahiskalioglu ,
Mehmet Dumlu Aydın ,
Deniz Sirinoglu
DOI: 10.5137/1019-5149.JTN.48356-24.2
Article in Press
Corresponding Author:
Mehmet Kursat Karadag (drkursatkaradag@gmail.com)
Abstract
Aim
Chronic subdural hematoma (CSDH) is an encapsulated collection of blood at different stages of coagulation that accumulates at the dural border cell layer. However, the mechanisms underlying the development of de novo vessels in the inner membranes after CSDH remain unclear. This study aims to investigate the histological features of this process.
Material and Methods
The study analyzed the inner membranes from 17 CSDH cases. These membranes were excised along with the dural parts and examined using immunohistochemical techniques under light microscopy. The volume of the inner membranes and the number of neovascularized arterioles covered by astrocyte-like cells were compared using the Mann-Whitney U test.
Results
The branches of the dural artery and nerves towards the inner membranes resulted in the formation of blood-brain barrier-like arteriolar structures, covered by astrocyte-like cells. The mean volume of the inner membrane was 94.45 ± 28.34 cm³. It ranged from 88-105 cm³ (n = 5) in Group A, >105 cm³ (n = 6) in Group B, and <88 cm³ (n = 6) in Group C. The number of astrocyte-like cells was 15.236 ± 1.218, 21.561 ± 3.267, and 10.298 ± 1.856 for Groups A, B, and C, respectively (p < 0.00005).
Conclusion
This study suggests that the dural sites, where the inner membrane attaches to the dura mater, are likely the origin of CSDH bleeding. We also identified the arteria nervorum, a neurological structure in this region, which may be the source of newly formed arteries. These arteriae nervorum may give rise to arterioles with features resembling the blood-brain barrier.
Chronic subdural hematoma (CSDH) is an encapsulated collection of blood at different stages of coagulation that accumulates at the dural border cell layer. However, the mechanisms underlying the development of de novo vessels in the inner membranes after CSDH remain unclear. This study aims to investigate the histological features of this process.
Material and Methods
The study analyzed the inner membranes from 17 CSDH cases. These membranes were excised along with the dural parts and examined using immunohistochemical techniques under light microscopy. The volume of the inner membranes and the number of neovascularized arterioles covered by astrocyte-like cells were compared using the Mann-Whitney U test.
Results
The branches of the dural artery and nerves towards the inner membranes resulted in the formation of blood-brain barrier-like arteriolar structures, covered by astrocyte-like cells. The mean volume of the inner membrane was 94.45 ± 28.34 cm³. It ranged from 88-105 cm³ (n = 5) in Group A, >105 cm³ (n = 6) in Group B, and <88 cm³ (n = 6) in Group C. The number of astrocyte-like cells was 15.236 ± 1.218, 21.561 ± 3.267, and 10.298 ± 1.856 for Groups A, B, and C, respectively (p < 0.00005).
Conclusion
This study suggests that the dural sites, where the inner membrane attaches to the dura mater, are likely the origin of CSDH bleeding. We also identified the arteria nervorum, a neurological structure in this region, which may be the source of newly formed arteries. These arteriae nervorum may give rise to arterioles with features resembling the blood-brain barrier.
Keywords
Chronic Subdural Hematoma
inner Membrane
Dura mater
Blood-Brain Barrier