Correlation Between VEGF And ANG-2 Levels And Postoperative Recurrence In Patients With Chronic Subdural Hematoma

Objective: Previous clinical studies has explored extensively risk factors predicting recurrence of chronic subdural hematoma(CSDH)after surgical evacuation.Nevertheless,the potential pathophysiological mechanisms are still unknown.This study aimed to investigate the role of vascular endothelial growth factor(VEGF)and angiopoietin-2(ANG-2)in postoperative recurrence of CSDH.Methods: The peripheral venous blood,hematoma fluid and outer membrane of CSDH patients who underwent burr-hole drainage in Qinghai provincial people’s hospital from May 2019 to October 2021 were prospectively collected.Enzyme-linked immunosorbent assay was used to detect the concentrations of VEGF and ANG-2 in serum and hematoma fluid,and western blotting was used to measure the concentrations of VEGF and ANG-2 in outer membrane.Patients were divided into recurrence group(radiological recurrence with corresponding neurological dysfunction)and non-recurrence group during the 3-month follow-up.Concentrations of VEGF and ANG-2 in peripheral blood,hematoma fluid and outer membrane between the two groups were compared.Result: In all,57 patients with CSDH were identified.The CSDH recurred in 12(21.1%)of the 57 patients.Serum VEGF and ANG-2 concentrations in the recurrence group were slightly higher than those in the non-recurrent group.But the differences were not statistically significant.However,the concentrations of CSDH hematoma fluid VEGF and ANG-2 in the recurrent group were significantly higher than those in another group(p < 0.05).Western blotting was performed on the outer membrane samples of 8 patients randomly selected from the 2 groups,respectively.The results indicated that the concentrations of VEGF and ANG-2 in outer membrane of the recurrence group was significantly increased compared with that of the non-recurrence group(p < 0.05).Conclusion: Serum VEGF and ANG-2 are not useful as independent predictors of postoperative recurrence of CSDH.Higher levels of VEGF and ANG-2 in hematoma fluid and outer membrane are correlated with CSDH recurrence after surgical evacuation.The formation of pathological capillaries and continuous blood oozing are the possible pathophysiological mechanisms of postoperative recurrence of CSDH,and the rational use of drugs promoting vascular maturation may prevent recurrence of CSDH.