gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Angiotensin converting enzyme (ACE) inhibition for arterial hypertension lowers the risk of recurrent chronic subdural hematoma (CSH) by an anti-angiogenic mechanism

Inhibition des Angiotensin Converting Enzyms (ACE) zur Blutdruckeinstellung senkt das Risiko einer Rezidiventwicklung beim chronisch subduralen Hämatom (CSH) über einen antiangiogenen Effekt

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  • corresponding author L. Schlickum - Abt. für Neurochirurgische Forschung, Neurochirurgische Klinik, Universitätklinikum Mannheim
  • A. Hohenstein - Abt. für Neurochirurgische Forschung, Neurochirurgische Klinik, Universitätklinikum Mannheim
  • L. Schilling - Abt. für Neurochirurgische Forschung, Neurochirurgische Klinik, Universitätklinikum Mannheim
  • R. Weigel - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-11.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0137.shtml

Published: May 4, 2005

© 2005 Schlickum et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

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.

Methods

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.

Results

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).

Conclusions

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