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JOURNAL OF NEUROSURGICAL SCIENCES

A Journal on Neurosurgery


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Journal of Neurosurgical Sciences 2017 October;61(5):536-43

DOI: 10.23736/S0390-5616.16.03156-8

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Chronic subdural hematoma pathophysiology: a unifying theory for a dynamic process

Giulio CECCHINI 1, 2

1 Department of Neurology and Neuropsychiatry Sciences, University of Bari, Bari, Italy; 2 University of Marche, Ancona, Italy


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Chronic subdural hematoma pathophysiology has been extensively studied and discussed. In the last decades, optic and electron microscope observations have successfully described its histopathology and the ultrastructure of internal membranes. Moreover, recent biochemical studies have identified a number of important pathways involved in its development and evolution. Our aim was to review recent literature regarding histopathology, ultrastructure and biochemichal pathways and supply a unifying theory about chronic subdural hematoma pathophysiology. The starting point of chronic subdural hematoma is a mechanical injury. The evolution of the pathology is due to the exclusive anatomy of the dura-arachnoid interface. This is a mechanically weak layer. Fibroblasts contained in this region produce an inflammatory reaction with neoangiogenesis and fibrinolysis. Biochemical pathways involved in these reactions is complex and could contain a number of pharmacological targets. The hematoma evolves in different stages thus recent outlooks consider chronic subdural hematoma as a dynamic process. One of the key points for a good outcome and a low recurrence rate may be the timing of the surgical treatment in relation of hematoma natural history. Surgery performed during active inflammatory stages may be less effective in terms of clinical outcome and recurrence rate.


KEY WORDS: Hematoma, subdural, chronic - Membranes - Pathophysiology

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Publication History

Issue published online: July 17, 2017
Article first published online: February 12, 2015
Manuscript accepted: February 10, 2015
Manuscript revised: January 23, 2015
Manuscript received: November 28, 2014

Cite this article as

Cecchini G. Chronic subdural hematoma pathophysiology: a unifying theory for a dynamic process. J Neurosurg Sci 2017;61:536-43. DOI: 10.23736/S0390-5616.16.03156-8

Corresponding author e-mail

cecchinigiulio@hotmail.it