Possible role of cyclooxygenase-2 in developing chronic subdural hematoma

Inflammatory cytokines are reportedly involvedin the pathogenesis of chronic subdural hematomas(CSH), and the angiogenesis of hematomashas particularly been in focus. Cyclooxygenase-2(COX-2) is an essential enzyme for the synthesis ofprostaglandin E2 (PGE2). The COX-2-PGE2 pathwayhas been shown to influence angiogenic factorssuch as vascular endothelial growth factor (VEGF).We investigated the association of COX-2 expressionin the dura mater and outer membrane withthe pathogenesis of CSH, and suggested a treatmentstrategy on the basis of this association.Hematoma fluid and serum samples obtained from37 patients, and samples of the dura mater andouter CSH membrane obtained from 13 patientsduring the operation were examined in this study.The concentrations of PGE2 in relation to COX-2 inthe hematoma fluid were significantly higher thanthose in the serum. Immunohistochemical analysesrevealed COX-2-positive cells in the outer membraneof CSHs. There was a linear and significantrelationship between PGE2 concentration in hematomafluid and the interval from trauma to initialsurgery. COX-2 may play a crucial role during thedevelopment of CSHs. Our study might lead to thedevelopment of anti-COX-2 treatment options thataim to minimize repeat surgery and choose medicaltherapy by reducing CSH morbidity and recurrencerate in patients with CSH.