gms | German Medical Science

Chronic subdural hematoma is characterized by an outer membrane with a rich an pathological vascularization. There is growing evidence that angiogenic mechanisms are involved in the formation of leaky vessels leading to hematoma enlargement and recurrence. We tested the hypothesis that the antiangiogenic effect of ACE-inhibition for arterial hypertension also reduces the risk of recurrence in CSH.

We analysed retrospectively the data of 392 patients with CSH treated in our department between 1995 and 2002. Only patients who underwent a standard procedure with one or two burrholes and postoperative drainage were evaluated. Patients with coagulopathies and independent neurological disorders were excluded from the study. Patient records were screened for age, gender, preoperative and postoperative Markwalder score, arterial hypertension, medication with ACE-inhibitors, and recurrence of CSH. Recurrence was defined as an increasing lesion on the operated side in cross sectional imaging and concomittant neurological deterioration within 6 months postoperatively. Additionally, in 40 consecutive patients who met the inclusion criteria the concentration of vascular endothelial growth factor (VEGF) was analysed within hematoma samples and corresponding venous blood.

Overall 279 patients met the inclusion criteria. Demographic data of group A (ACE-inhibitors) and group B (non ACE-inhibitors) did not differ significantly. Five of 46 (11%) patients in group A suffered recurrence from CSH whereas 62 of 233 (27%) in group B needed a second or third operation (p<0.05). A negative correlation was found between the yearly rates of medication with ACE-inhibitors and recurrence (r=-0.7; p<0.05). The concentration of VEGF in the hematoma was significantly lower in group A (7314 pg/ml versus 14494 pg/ml, p=0.01).

ACE-inhibition for arterial hypertension lowers the risk of recurrence in patients operated for CSH by an anti-angiogenic mechanism.