Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): Evidence for an angiogenic disease

Background. The aim of this prospective study was to evaluate the significance of growth factors as determinants of the pathological degree of neovascularisation found in the parietal neomembrane of chronic subdural hematoma (CSH). Thus far the pathogenesis of the vascularisation has not been elucidated. Method, The concentrations of growth factors, i.e. vascular endothelial derived growth factor (VEGF), basic fibroblast growth factor (bFGF) and platelet derived growth factor (PDGF) were determined using ELISA technique in hematoma fluid and serum of 20 patients with uni- or bilateral CSH. For comparison, growth factor concentrations were determined in cerebrospinal fluid (CSF) patients undergoing diagnostic myelography. Findings. Concentrations of VEGF and bFGF were significantly (p < 0.001) increased in the hematoma fluid as compared with serum (VEGF(h) = 8,142 pg/ml, bFGF(h) = 8.7 pg/ml versus VEGF(s) = 368 pg/ml, bFGF, = 1.8 pg/ml), In contrast, PDGF concentration was significantly (p < 0.001) lower in the hematoma (PDGF(h) = 3,456 pg/ml versus PDGF(s) = 31,937 pg/ml). The serum levels for VEGF, bFGF and PDGF in CSH patients lay within the range of normal volunteers. No growth factors were found in normal CSF. Interpretation. These results reveal a specific distribution pattern of growth factors in CSH patients. This pattern suggests that CSH may be considered a member of the angiogenic disease family.