Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence.
OBJECTIVE
Chronic subdural hematomas (CSDHs) recur in 7 to 18% of cases. The present study was conducted to determine whether serum or lesion concentrations of coagulofibrinolytic and angiogenic factors, which have been reported to be potential markers of CSDH development, might predict such recurrences.


METHODS
Sixty consecutive patients (mean age 71.5 years) with CSDHs (74 affected sides) were studied. Samples of serum in preoperative peripheral venous blood and of hematomas (obtained during surgery) were collected and analyzed. The CSDH recurred in six (8.1%) of the 74 affected sides in six patients. None of the values of the coagulative factors or tests in serum showed significant variation between cases with and those without recurrence. Among coagulofibrinolytic factors, tissue plasminogen activator (TPA) in hematomas demonstrated significantly greater levels in recurrent than in nonrecurrent cases; a similar tendency was noted for alpha2-plasmin inhibitor-plasmin complex in hematomas. Both factors were greater in the lesions than in the serum. Among the angiogenic factors, levels of hepatic growth factor (HGF) and vascular endothelial growth factor (VEGF) in hematomas were significantly greater than in serum, whereas those of basic fibroblast growth factor were rather lower. Note that comparisons between recurrent and nonrecurrent cases revealed no significant difference.


CONCLUSIONS
Patients harboring CSDHs with high TPA concentrations on sampling at the initial surgery have a relatively high probability of recurrence and require follow up with computerized tomography scanning. Angiogenic factors, such as HGF and VEGF, might be candidate markers of CSDH enlargement but are not useful as predictors of recurrence.
Katano
Hiroyuki
H
Department of Neurosurgery and Restorative Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. katano@med.nagoya-cu.ac.jp
Kamiya
Ken
K
Mase
Mitsuhito
M
Tanikawa
Motoki
M
Yamada
Kazuo
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002908:Chronic Disease; D005260:Female; D005343:Fibrinolytic Agents / Q000097:blood*; D006408:Hematoma, Subdural / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D010959:Tissue Plasminogen Activator / Q000097:blood*
D015415:Biomarkers; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator