Kvantitativna analiza kapsularne mikrovaskularizacije u odnosu na debljinu hroničnog subduralnog hematoma
Sažetak
Uvod/Cilj. Hronični subduralni hematom (chronic subdural hematoma – CSDH) je ekstraaksijalna, inkapsulirana, sporo rastuća kolekcija krvi, praćena lokalnom koagulopatijom. Ovo doprinosi kontinuiranom ponovnom krvarenju iz novoformirane kapsule hematoma, što dovodi do sporog, ali progresivnog uvećanja hematoma sa potencijalom da se razvije u kompresivnu intrakranijalnu leziju. Cilj rada bio je da se ispita odnos između proliferacije sinusoidnih krvnih sudova i rasta i prečnika CSDH. Metode. U ovoj studiji, analizirana su 33 slučaja CSDH koja su operativno lečena. Uzet je uzorak biopsije iz parijetalne kapsule hematoma (prosečne veličine 3 × 3 mm). Uzorci tkiva dobijeni biopsijom fiksirani su u 4% vodenom rastvoru formaldehida, rutinski su pripremljeni parafinski preseci na pločicama i obojeni imunohistohemijskim metodama u cilju detekcije prisutva CD34 antigena. Profili krvnih sudova mikrovaskularne mreže koji su ispoljavali CD34 su kvantifikovani, a broj CD34 pozitivnih kapilara i sinusoida izražen je po jednom mm2. Rezultati. Varijable starost i broj krvnih sudova pokazale su statistički značajnu povezanost sa povećanjem zapremine hematoma (β = 0,422; p = 0,007; β = 0,486; p = 0,022, redom). Stariji bolesnici imali su veći rizik od uvećanja zapremine hematoma, kao i bolesnici sa većim brojem sinusoidnih krvnih sudova. Zaključak. Broj sinusoida u parijetalnoj kapsuli CSDH po jedinici površine od 1 mm2 pozitivno korelira sa debljinom hematoma, što naglašava značaj vaskularne teorije u razvoju hematoma. Iako je CSDH jedno od najčešćih neurohirurških oboljenja, njegova patogeneza još uvek nije potpuno razjašnjena. Dalja istraživanja u ovoj oblasti neophodna su kako bi se razvile potencijalno nove terapijske opcije koje bi pružile sveobuhvatnije modalitete lečenja.
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