gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Occurence and recurrence of chronic subdural hematoma are associated with deficiency of Factor XIII activity

Meeting Abstract

  • M. Molcanyi - Zentrum für Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • B. Bosche - Zentrum für Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • M. Kochanek - Klinik für Innere Medizin, Klinikum der Universität zu Köln, Köln
  • C. Dohmen - Klinik für Neurologie, Klinikum der Universität zu Köln, Köln
  • R. Goldbrunner - Zentrum für Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • G. Brinker - Zentrum für Neurochirurgie, Klinikum der Universität zu Köln, Köln

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.05.05

DOI: 10.3205/11dgnc130, URN: urn:nbn:de:0183-11dgnc1308

Published: April 28, 2011

© 2011 Molcanyi et al.
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Outline

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Objective: Chronic subdural hematoma (cSDH) may occur spontaneously and may occasionally be followed by re-bleeding. Its pathophysiology, however, is poorly understood. Since the coagulation factor XIII (FXIII) is additionally involved in angiogenesis, endothelial barrier function and wound healing, we evaluated a potential role of FXIII in cSDH and its recurrence.

Methods: We analyzed the initial plasma activity of FXIII and standard coagulation parameters of 36 individuals (18 cSDH-patients/18 healthy controls). In addition, we assessed clinical data, the number of hematoma compartments, the approximate volume of cSDH and the occurrence of a relevant re-bleeding requiring a second neurosurgical treatment. Typical risk factors for cSDH were excluded.

Results: All cSDH-patients had none or just a negligible trauma. Six patients had bilateral and 12 unilateral cSDH. CSDH-patients showed significantly lower FXIII activities than the control group (65 [52.75-80.25] % vs. 93 [81-111] %, p = 0.001), whereas standard coagulation parameters showed no significant differences. Six patients developed a relevant re-bleeding after treatment requiring repeated surgery. These patients expressed a significantly lower initial FXIII activity compared to the other 12 cSDH-patients (47.5 [33.5-64] % vs. 78.5 [58-87] %, p = 0.005). A cut-off value of FXIII less than 68.5% was identified as the best predictor for a relevant re-bleeding (sensitivity: 100%, specificity: 75%, p = 0.007).

Conclusions: FXIII may play a relevant role in the pathophysiology of cSDH, although it remains uncertain, whether the FXIII deficiency is the cause or an epiphenomenon of cSDH. However, its substitution may serve as a therapeutic option to prevent re-bleedings.